Innovations In Education

Journal of General Internal Medicine

, Volume 20, Issue 8, pp 769-771

First online:

The outcomes card

Development of a systems-based practice educational tool
  • Anne TomoloAffiliated withCase Western Reserve University School of MedicineLouis Stokes Cleveland DVAMC Email author 
  • , Aleece CaronAffiliated withLouis Stokes Cleveland DVAMC
  • , Michelle L. PerzAffiliated withLouis Stokes Cleveland DVAMC
  • , Troy FultzAffiliated withLouis Stokes Cleveland DVAMC
  • , David C. AronAffiliated withCase Western Reserve University School of MedicineLouis Stokes Cleveland DVAMC

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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 safety medical education program evaluation