title: A self-instructional model to teach systems-based practice and practice-based learning and improvement.
abstract: BACKGROUND
  When mandated as resident competencies in 1999, systems-based practice (SBP) and practice-based learning and improvement (PBLI) were new concepts to many.
  
  
  OBJECTIVE
  To describe and evaluate a 4-week clinical elective (Achieving Competence Today-ACT) to teach residents SBP and PBLI.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA, USA. toni_peters@hms.harvard.edu
authors.forename: Antoinette S
authors.initials: AS
authors.lastname: Peters
authors.forename: Joe
authors.initials: J
authors.lastname: Kimura
authors.forename: Maryjoan D
authors.initials: MD
authors.lastname: Ladden
authors.forename: Elizabeth
authors.initials: E
authors.lastname: March
authors.forename: Gordon T
authors.initials: GT
authors.lastname: Moore
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D003695:Delivery of Health Care / Q000458:organization & administration; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D017145:Models, Educational