Date: 28 Feb 2008
What indicates competency in systems based practice? An analysis of perspective consistency among healthcare team members
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In many parts of the world the practice of medicine and medical education increasingly focus on providing patient care within context of the larger healthcare system. Our purpose is to solicit perceptions of all professional stakeholders (e.g. nurses) of the system regarding the U.S. ACGME competency Systems Based Practice to uncover the extent to which there is agreement or discrepancy among key system stakeholders. Eighty-eight multidisciplinary personnel (n = 88) from two academic medical centers were invited to participate in one of 14 nominal group process sessions. Participants generated and prioritized resident characteristics that they believed were important for effective System Based Practices. Through content analysis the prioritized attribute statements were coded to identify embedded themes of resident roles and behavior. From the themes, three major resident roles emerged: resident as Self-Manager, Team Collaborator, and Patient Advocate. No one professional group (e.g., nurses, attending physicians, social workers) emphasized all of these roles. Some concepts that are emphasized in the ACGME definition like using cost–benefit analysis were conspicuously absent from the healthcare team generated list. We showed that there are gaps between the key stakeholders prioritizations about the ACGME definition of SBP and, more generally, the behaviors and roles identified by healthcare team stakeholders beyond the U.S. This suggests that within the process of developing a comprehensive working understanding of the Systems Based Practice competency (or other similar competencies, such as in CanMEDS), it is necessary to use multiple stakeholders in the system (perhaps including patients) to more accurately identify key resident roles and observable behaviors.
ACGME outcomes project webpage (2007). Viewed 10 Sept. 2007. http://www.acgme.org/outcome/compFull.asp#6
American College of Physicians (ACP) (2008). Achieving a high-performance health care system with universal access: What the United States can learn from other countries. Annals of Internal Medicine, 148(1), 55–75.
Aspinal, F., et al. (2005). What is important to measure in the last months and weeks of life?: A modified nominal group study. International Journal of Nursing Students.
Baker, L. M. (2004). Information needs at the end of life: A content analysis of one person’s story. Journal of the Medical Librarians Association, 92(1), 78–82.
Bleakley, A. (2007). Medical education in transition and the patient as transitional object. Graduate Medical Education Plenary presentation. Washington, D.C.: Association of American Medical Colleges.
Carney, O., McIntosh, J., & Worth, A. (1996). The use of the Nominal Group Technique in research with community nurses. Journal of Advanced Nursing, 23(5), 1024–1029.CrossRef
Chatterji, M. (2004). Evidence on “What Works”: An argument for extended-term mixed-method (etmm) evaluation designs. Educational Researcher, 34(5), 14–24.CrossRef
David, R. A., & Reich, L. M. (2005). The creation and evaluation of a systems-based practice/managed care curriculum in a primary care internal medicine residency program. Mt Sinai Journal of Medicine, 72(5), 296–299.
Dyne, P. L., Strauss, R. W., & Rinnert, S. (2002). Systems-based practice: The sixth core competency. Academic Emergency Medicine, 9(11), 1270–1277.CrossRef
Englander, R., Agostinucci, W., Zalneraiti, E., & Carraccio, C. L. (2006). Teaching residents systems-based practice through a hospital cost-reduction program: A “win-win” situation. Teaching and Learning in Medicine, 18(2), 150–152.CrossRef
Epstein, R. M. (2007). Assessment in medical education. The New England Journal of Medicine, 356(4), 387–396.CrossRef
Frank J. R. (Ed.). (2005). The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada.
Frank, J. R., & Danoff, D. (2007). The CanMEDS initiative: Implementing an outcomes-based framework of physician competencies. Medical Teacher, 29, 642–647.CrossRef
Legrow, K., & Rossen, B. E. (2005). Development of professional practice based on a family systems nursing framework: Nurses’ and families’ experiences. Journal of Family Nursing, 11(1), 38–58.CrossRef
General Medical Council (GMC) [Great Britain]. Good medical practice. (2006). http://www.gmc-uk.org/guidance/good_medical_practice/index.asp. Viewed on Jan. 29, 2008.
Institute of Medicine, Committee on Quality of Health Care in America (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, D.C.: National Academy Press.
Kvarnstorm, S., & Cedersund, E. (2006). Discursive patterns in multiprofessional healthcare teams. Journal of Advanced Nursing, 53(2), 244–252.CrossRef
Lancet (2001). Educating doctors for world health. Lancet: London, 358(9292), 3 November 2001.
Lingard, L., Espin, S., Evans, C., & Hawryluck, L. (2004). The rules of the game: Interprofessional collaboration on the intensive care unit team. Critical Care, 8(6), R403–R408.CrossRef
Moon, R. H. (1999). Finding diamonds in the trenches with the nominal group process. Family Practice Management, 6(5), 49–50.
Owen J. W., & Roberts O. (2005) Globalization, health, and foreign policy: Emerging linkages and interests. Globalization and Health, 1(12), 1744–8603 2005.
Panek, R. C., Deloney, L. A., Park, J., Goodwin, W., Klein, S., & Ferris, E. J. (2006). Interdepartmental problem-solving as a method for teaching and learning systems-based practice. Academic Radiology, 13(9), 1150–1154.CrossRef
Palmer, K. T., Harling, C. C., Harrison, J., Macdonald, E. B., & Snashall, D. C. (2002). Good medical practice: Guidance for occupational physicians. Occupational Medicine, 52(6), 341–352.CrossRef
Pasquina, P. F., Kelly, S., & Hawkins, R. E. (2003). Assessing clinical competence in physical medicine & rehabilitation residency programs. American Journal of Physical Medicine Rehabilitation, 82(6), 473–478.CrossRef
Ranz, J. M., Vergare, M. J., Wilk, J. E., Ackerman, S. H., Lippincott, R. C., Menninger, W. W., et al. (2006). The tipping point from private practice to publicly funded settings for early- and mid-career psychiatrists. Psychiatric Service, 57(11), 1640–1643.CrossRef
Reisdorff, E. J., Hayes, O. W., Walker, G. L., & Carlson, D. J. (2002). Evaluating systems-based practice in emergency medicine. Academic Emergency Medicine, 9(11), 1350–1354.CrossRef
Ringsted, C., Hansen, T. L., Davis, D., & Schepbier, A. (2006). Are some of the challenging aspects of the CanMEDS roles valide outside Canada? Medical Education, 40, 807–815.CrossRef
Romanow, R. (2002). Building on values: The future of health care in Canada. Commission on the Future of Health Care in Canada.
Saleh, K. J., Macaulay, A., Radosevich, D. M., Clark, C. R., Engh, G., Gross, A., et al. (2001). The Knee Society Index of Severity for failed total knee arthroplasty: Development and validation. Clinical Orthopedics Related Research, (392), 153–165.
Swing, S. R. (2002). Assessing the ACGME general competencies: General considerations and assessment methods. Academic Emergency Medicine, 9(11), 1278–1288.CrossRef
Tomolo, A., Caron, A., Perz, M. L., Fultz, T., & Aron, D. C. (2005). The outcomes card. Development of a systems-based practice educational tool. Journal of General Internal Medicine, 20(8), 769–771.CrossRef
Zenni, E. A., Ravago, L., Ewart, C., Livingood, W., Wood, D., & Goldhagen, J. (2006). A walk in the patients’ shoes: A step toward competency development in systems-based practice. Ambulatory Pediatrics, 6(1), 54–57.CrossRef
- What indicates competency in systems based practice? An analysis of perspective consistency among healthcare team members
Advances in Health Sciences Education
Volume 14, Issue 2 , pp 187-203
- Cover Date
- Print ISSN
- Online ISSN
- Springer Netherlands
- Additional Links
- Systems base practice
- United States Accreditation Council on Graduate Medical Education
- Resident competency
- Nominal group process
- Industry Sectors
- Author Affiliations
- 1. Center for Education Research and Evaluation: New York-Presbyterian Hospital at Columbia University Medical Center and Weill Cornell Medical Center, New York, NY, 10032, USA
- 2. Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
- 3. Sanofi-Aventis Pharmaceuticals, Bridgewater, NJ, USA