Abstract
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.
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Notes
Five other competency areas designated by ACGME are Medical Knowledge, Professionalism, Patient Care, Interpersonal and Communication Skills, and Practice-Based Learning and Improvement.
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Acknowledgements
The Stemmler Fund for Medical Education Research from the National Board of Medical Examiners supported this research. All findings and statements are, however, the sole opinions of the authors. We thank all the health team members for making time to participate in this study. We also thank Gingi Pica, Sarah Steinberg, and Brianna Moore for their help with data collection and analysis for this project. We acknowledge the thoughtful critiques of an earlier draft of this manuscript by Glenn Regehr, Sharon Krackov, Boyd Richards, and two anonymous reviewers.
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Appendix A
Appendix A
The Accreditation Council of Graduate Medical Education’s definiition of systems-based practice
Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:
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work effectively in various health care delivery settings and systems relevant to their clinical specialty;
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coordinate patient care within the health care system relevant to their clinical specialty;
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incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate;
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advocate for quality patient care and optimal patient care systems;
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work in inter-professional teams to enhance patient safety and improve patient care quality; and
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participate in identifying system errors and implementing potential systems solutions.
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Graham, M.J., Naqvi, Z., Encandela, J.A. et al. What indicates competency in systems based practice? An analysis of perspective consistency among healthcare team members. Adv in Health Sci Educ 14, 187–203 (2009). https://doi.org/10.1007/s10459-008-9106-6
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DOI: https://doi.org/10.1007/s10459-008-9106-6