title: The outcomes card. Development of a systems-based practice educational tool.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  Develop an educational tool, Outcomes Card (OC), to reinforce core concepts of SBP.
  
  
  METHODS
  Urgent Care Center at Louis Stokes Cleveland Department of Veterans Affairs Medical Center.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 (kappa=0.88 and 0.95, respectively), and for system identification was good (kappa=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.
  
  
  CONCLUSIONS
  This pilot study suggests that OCs are feasible and reliable educational tools for enhancing competence in SBP.
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio 44106, USA. anne.tomolo@med.va.gov
authors.forename: Anne
authors.initials: A
authors.lastname: Tomolo
authors.forename: Aleece
authors.initials: A
authors.lastname: Caron
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Perz
authors.forename: Troy
authors.initials: T
authors.lastname: Fultz
authors.forename: David C
authors.initials: DC
authors.lastname: Aron
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards; D003479:Curriculum; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D019300:Medical Errors; D017145:Models, Educational; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects