A Self-instructional Model to Teach Systems-based Practice and Practice-based Learning and Improvement
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.
KEY WORDSresidency training systems-based practice practice-based learning and improvement
- 1.ACGME Outcome Project, Competency Descriptions, (http://www.acgme.org/outcome/comp/GeneralCompetenciesStandards21307.pdf). Accreditation Council for Graduate Medical Education, Chicago, IL, last accessed January 7, 2008.
- 8.ACGME Outcome Project, Assessment Toolbox, (http://www.acgme.org/outcome/assess/toolbox.asp). Accreditation Council for Graduate Medical Education, Chicago, IL, last accessed January 7, 2008.
- 9.ACGME Outcome Project, Instructional Toolbox, (http://www.acgme.org/outcome/instrmod/instrModHome.asp) Accreditation Council for Graduate Medical Education, Chicago, IL, last accessed January 7, 2008.
- 19.Knowles M, Holton EF, Swanson RA. The Adult Learner: The Definitive Classic in Adult Education and Human Resource Development. Woburn, MA: Butterworth-Heinemann; 1998.Google Scholar