spanning seven domains. these competency domains are (1) systems science; (2) research questions and standards of scientific evidence; (3) research methods; (4) informatics; (5) ethics of research and implementation in health systems; (6) improvement and implementation science; (7) engagement, leadership, and research management. an 8th domain, equity and justice, was added in 2022 and a total of 38 competencies are now identified. these competencies form the backbone of a training program collaboratively funded by ahrq and pcori, two us funding agencies that also issue funding opportunities for lhs-related studies. a $40 million funding opportunity for mentored career development awards was issued in 2017 and 11 centers of excellence were awarded five years of federal funding in 2018 to support the training of clinician and research scientists to conduct patient-centered outcomes research within lhs. the lhs centers of excellence funded in 2018 were: a chicago center of excellence in learning health systems research training (accelerat), northwestern university, chicago, ill. catalyst: consortium for applied training to advance the learning health system with scholars/trainees, kaiser permanente washington research institute, seattle, wa. learning health system scholar program at vanderbilt university, nashville, tenn. leveraging infrastructure to train investigators in patient-centered outcomes research in learning health system (liti- pcorlhs), indiana university school of medicine, indianapolis, ind. minnesota learning health system mentored career development program (mn-lhs), university of minnesota, minneapolis, minnesota. northwest center of excellence & k12 in patient centered learning health systems science, oregon health and science university, portland, oregon. pedsnet scholars: a training program for pediatric learning health system researchers, children’s hospital of philadelphia, philadelphia, pa stakeholder-partnered implementation research and innovation translation (spirit) program, university of california los angeles, los angeles, california. the center of excellence in promoting lhs operations and research at einstein/montefiore (explore), albert einstein college of medicine, bronx, n.y. transforming the generation and adoption of pcor into practice (t-gapp), university of pennsylvania, philadelphia, pa. university of california-san francisco learning health system k12 career development program, university of california san francisco, san francisco, california. as the funding for the aforementioned centers of excellence concludes in 2023, a successor funding opportunity was created by ahrq and pcori to fund learning health system embedded scientist training and research (lhs e-star) centers. other similar training and fellowship programs have been offered by academyhealth via their delivery system science fellowship program, kaiser permanente’s division of research, and the veterans administration via the seattle-denver center of innovation. program offerings and emphases vary from institution to institution, but all involve training and professional development in topics related to improving health systems and the ability to generate and learn from evidence. articles describing multidisciplinary workforce training efforts was published as a supplement to the lhs journal in 2022 funding and financial support support for learning activities may be derived from federal, philanthropic, and other sources. examples include the national institutes of health and ahrq (federal); and the robert wood johnson foundation (philanthropic). the patient-centered outcomes research institute (pcori) has designated the realization of a national learning health system as one of their five national priorities for health, which is indicative of future funding opportunities. funding provided to personnel within an organization (i.e., a health system) may be designated for internally-directed learning activities with no expectation about developing and publishing generalizable results. in this way, learning health system may be distinguished from traditional health services or informatics research and more closely resemble the funding and infrastructure that health systems designate for quality improvement activities. in 2015, the centers for medicare and medicaid services (cms) funded the health care payment learning and action network to ascertain what works with respect to alternative health care delivery arrangements, however, reimbursement for learning activities from insurers/payers is not currently a steady avenue for financial support to incentivize health system learning. ethical considerations bioethics scholars including faden, asch, finkelstein, morain, and platt have averred that in a learning health system, consideration should be given to both clinical ethics and research ethics. faden, kass and colleagues have put forth an ethics framework for the learning health system that is anchored on seven essential obligations: (1) respecting dignity and rights of all patients; (2) respecting clinical judgment; (3) providing optimal care to every patient; (4) avoiding the introduction of non-clinical burdens and risks; (5) reducing health inequities; (6) ensuring responsible activities are conducted in a way that fosters learning; and (7) contributing to the overall aim of improving quality and value in health care. this framework and several companion articles were published as a special report from the hastings center. subsequent articles by finkelstein et al, as well as asch and colleagues seek to use examples of learning activities as a means to describe different approaches to research oversight and compliance. rigorous deliberations about the approach to informed consent are also germane to the ethics of learning activities in the healthcare context.