Journal of General Internal Medicine

, 20:769

The outcomes card

Development of a systems-based practice educational tool


    • Louis Stokes Cleveland DVAMC
    • Case Western Reserve University School of Medicine
  • Aleece Caron
    • Louis Stokes Cleveland DVAMC
  • Michelle L. Perz
    • Louis Stokes Cleveland DVAMC
  • Troy Fultz
    • Louis Stokes Cleveland DVAMC
  • David C. Aron
    • Louis Stokes Cleveland DVAMC
    • Case Western Reserve University School of Medicine
Innovations In Education

DOI: 10.1111/j.1525-1497.2005.0168.x

Cite this article as:
Tomolo, A., Caron, A., Perz, M.L. et al. J Gen Intern Med (2005) 20: 769. doi:10.1111/j.1525-1497.2005.0168.x


INTRODUCTION: The Accreditation Council for Graduate Medical Education requires competence in systems-based practice (SBP) demonstrating understanding of complex interactions between systems of care and its impact upon care delivery. Patient safety is a useful vehicle to facilitate learning about these interactions.

AIM: Develop an educational tool, Outcomes Card (OC), to reinforce core concepts of SBP.

SETTING: Urgent Care Center at Louis Stokes Cleveland Department of Veterans Affairs Medical Center.

PROGRAM DESCRIPTION: Pilot study of an educational intervention for residents that included patient safety didactic sessions and analysis of 2 self-identified clinical cases using the OC. Residents entered the following information on the OC: case description, type of event (error, near miss, and/or adverse event), error type(s), systems, and system failures.

PROGRAM EVALUATION: Two reviewers independently analyzed 98 cards completed during 60 two-week trainee rotations (81.7% return rate). Interrater reliability for error types between residents and physician supervisor and between reviewers was excellent (κ=0.88 and 0.95, respectively), and for system identification was good (κ=0.66 and 0.68, respectively). The self-assessment survey (56.6% return rate) suggests that residents improved their knowledge of patient safety and had positive attitudes about the curriculum.

DISCUSSION: This pilot study suggests that OCs are feasible and reliable educational tools for enhancing competence in SBP.

Key words

patient safetymedical educationprogram evaluation

Copyright information

© Society of General Internal Medicine 2005