Journal of General Internal Medicine

, Volume 23, Issue 7, pp 931–936 | Cite as

A Self-instructional Model to Teach Systems-based Practice and Practice-based Learning and Improvement

  • Antoinette S. Peters
  • Joe Kimura
  • MaryJoan D. Ladden
  • Elizabeth March
  • Gordon T. Moore
Original Article



When mandated as resident competencies in 1999, systems-based practice (SBP) and practice-based learning and improvement (PBLI) were new concepts to many.


To describe and evaluate a 4-week clinical elective (Achieving Competence Today—ACT) to teach residents SBP and PBLI.


ACT consisted of a four-week active learning course and follow-up teaching experience, guided and supported by web-based materials. The curriculum included readings, scheduled activities, work products including an improvement project, and weekly meetings with a non-expert preceptor. The evaluation used a before–after cross-comparison of ACT residents and their peers.


Seventy-eight residents and 42 faculty in 18 US Internal Medicine residency programs participated between 2003 and 2005.

Results and Main Measurements

All residents and faculty preceptors responded to a knowledge test, survey of attitudes, and self-assessment of competency to do 15 tasks related to SBP/PBLI. All measures were normalized to a 100-point scale. Each program’s principal investigator (PI) identified aspects of ACT that were most and least effective in enhancing resident learning. ACT residents’ gains in knowledge (4.4 on a 100-point scale) and self-assessed competency (11.3) were greater than controls’ (−1.9, −8.0), but changes in attitudes were not significantly different. Faculty preceptors’ knowledge scores did not change, but their attitudes became more positive (15.8). PIs found a ready-to-use curriculum effective (rated 8.5 on a 10-point scale).


ACT increased residents’ knowledge and self-assessment of their own competency and raised faculty’s assessment of the importance of residents’ learning SBP/PBLI. Faculty content expertise is not required for residents to learn SBP/PBLI.


residency training systems-based practice practice-based learning and improvement 


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Antoinette S. Peters
    • 1
    • 2
  • Joe Kimura
    • 1
    • 3
  • MaryJoan D. Ladden
    • 1
  • Elizabeth March
    • 1
  • Gordon T. Moore
    • 1
  1. 1.Department of Ambulatory Care and PreventionHarvard Medical School and Harvard Pilgrim Health CareBostonUSA
  2. 2.Academy Center for Teaching and LearningHarvard Medical SchoolBostonUSA
  3. 3.Patient Operations ImprovementHarvard Vanguard Medical AssociatesBostonUSA

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