Advances in Health Sciences Education

, Volume 14, Issue 2, pp 187–203 | Cite as

What indicates competency in systems based practice? An analysis of perspective consistency among healthcare team members

  • Mark J. Graham
  • Zoon Naqvi
  • John A. Encandela
  • Carma L. Bylund
  • Randa Dean
  • Ayxa Calero-Breckheimer
  • Hilary J. Schmidt
Original Paper


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.


Systems base practice United States Accreditation Council on Graduate Medical Education CanMEDS Resident competency Nominal group process 


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Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Mark J. Graham
    • 1
  • Zoon Naqvi
    • 1
  • John A. Encandela
    • 1
  • Carma L. Bylund
    • 2
  • Randa Dean
    • 1
  • Ayxa Calero-Breckheimer
    • 1
  • Hilary J. Schmidt
    • 3
  1. 1.Center for Education Research and Evaluation: New York-Presbyterian Hospital at Columbia University Medical Center and Weill Cornell Medical CenterNew YorkUSA
  2. 2.Department of Psychiatry & Behavioral SciencesMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Sanofi-Aventis PharmaceuticalsBridgewaterUSA

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