Systems thinking as the integrative competency in undergraduate Family Medicine education: a cross-sectional evaluation of an integrated primary care block

Abstract

Background Family Medicine and Primary Health Care anchor effective health systems, yet undergraduate curricula have given them limited dedicated space. The COM353 Family Medicine and Primary Care block at Alfaisal University was created to give these areas more dedicated curricular space, combining didactic teaching, Primary Health Care Center (PHCC) visits, structured reflection, and explicit engagement with clinical uncertainty. Methods We conducted a single-institution, cross-sectional quantitative evaluation of third-year medical students who completed the block in January 2026. A 42-item Likert instrument, adapted from the Dundee Ready Education Environment Measure (DREEM) and the Groningen Reflection Ability Scale (GRAS) with block-specific items, captured perceptions across seven domains. Of 126 enrolled students, 96 responded (76.2%). Analyses included descriptive statistics, internal-consistency reliability, inter-domain correlations, and multiple linear regression. Reporting follows the STROBE guideline. Results Domain means ranged from 3.90 to 4.27 (of 5), with all domains exceeding the scale midpoint by large margins (Cohen’s d, 0.92 to 1.58). Agreement rates ran from 63.7 to 80.7%. Internal consistency was excellent (Cronbach’s alpha = 0.988 overall; 0.940 to 0.974 across domains). Family Medicine and PHC Competencies achieved the highest mean (4.27) and reflective practice the lowest (3.90). On a single global rating, 87.5% of students rated the block positively (mean 3.80, SD 1.13). Multiple regression with six domains predicting perceived block value explained 78.2% of variance; F(6, 89) = 53.25, p < 0.001. Three domains independently predicted overall evaluation: Systems Thinking (beta = 0.727, p < 0.001), Reflection (beta = 0.295, p = 0.002), and Learning Environment (beta = 0.293, p = 0.013). Despite producing the highest absolute scores, Family Medicine Competencies did not independently predict overall evaluation, likely reflecting shared variance with Systems Thinking (r = 0.874). Conclusion A purposefully integrated Family Medicine block joining community-based experience, reflective practice, and explicit work with uncertainty appears to produce favorable educational outcomes across multiple domains. Of these, perceiving healthcare as an interconnected system most strongly predicted students’ overall evaluation, suggesting that systems thinking acts as the integrative thread giving other curricular elements coherence.