title: A systems approach for implementing practice-based learning and improvement and systems-based practice in graduate medical education.
abstract: The Accreditation Council for Graduate Medical Education (ACGME) initiated its Outcome Project to better prepare physicians-in-training to practice in the rapidly changing medical environment and mandated assessment of competency in six outcomes, including Practice-Based Learning and Improvement (PBLI) and Systems-Based Practice (SBP). Before the initiation of the Outcome Project, these competencies were not an explicit element of most graduate medical education training programs. Since 1999, directors of ACGME-accredited programs nationwide have been challenged to teach and assess these competencies. The authors describe an institution-wide curriculum intended to facilitate the teaching and assessment of PBLI and SBP competencies in the 115 ACGME-accredited residency and fellowship programs (serving 1,327 trainees) sponsored by Mayo School of Graduate Medical Education. Strategies to establish the curriculum in 2005 included development of a Quality Improvement (QI) curriculum Web site, one-on-one consultations with program directors, a three-hour program director workshop, and didactic sessions for residents and fellows on core topics. An interim program director self-assessment survey revealed a 13% increase in perceived ability to measure competency in SBP, no change in their perceived ability to measure competence in PBLI, a 15% increase in their ability to provide written documentation of competence in PBLI, and a 35% increase in their ability to provide written documentation of competence in SBP between 2005 and 2007. Nearly 70% of the programs had trainees participating in QI projects. Further research is needed to evaluate the cost-effectiveness of such a program and to measure its impact on learner knowledge, skills, and attitudes and, ultimately, on patient outcomes.
authors.affiliation: Department of Medicine, Mayo Clinic, [corrected] Rochester, Minnesota [corrected], USA. Varkey.prathibha@mayo.edu
authors.forename: Prathibha
authors.initials: P
authors.lastname: Varkey
authors.forename: Sudhakar
authors.initials: S
authors.lastname: Karlapudi
authors.forename: Steven
authors.initials: S
authors.lastname: Rose
authors.forename: Roger
authors.initials: R
authors.lastname: Nelson
authors.forename: Mark
authors.initials: M
authors.lastname: Warner
mesh_terms: D000068:Accreditation / Q000458:organization & administration*; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D011214:Practice, Psychological; D018794:Problem-Based Learning / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation; D013598:Systems Theory