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Health systems thinking (HST) is an important component of health systems science (HSS) curriculum in medical education. Currently, there is no operational definition for HST, making assessment of HST and HSS in medical education difficult and unreliable, especially at the undergraduate level. The development of an operational conceptualization and assessment of HST is an important step toward further developing HSS curricula in medical school. Drawing on Baartman & de Bruijnās (2011) framework of learning toward competency we frame HST as a process of solving problems within healthcare systems. In this paper we provide the results from an initial investigation to create an operational framework for the conceptualization and assessment of health systems thinking in undergraduate medical education.