title: Systems-based practice in graduate medical education: systems thinking as the missing foundational construct.
abstract: BACKGROUND
  Since 2001, residencies have struggled with teaching and assessing systems-based practice (SBP). One major obstacle may be that the competency alone is not sufficient to support assessment. We believe the foundational construct underlying SBP is systems thinking, absent from the current Accreditation Council for Graduate Medical Education competency language.
  
  
  CONCLUSIONS
  Systems thinking is defined as the ability to analyze systems as a whole. The purpose of this article is to describe psychometric issues that constrain assessment of SBP and elucidate the role of systems thinking in teaching and assessing SBP.
  
  
  CONCLUSIONS
  Residency programs should incorporate systems thinking models into their curricula. Trainees should be taught to understand systems at an abstract level, in order to analyze their own healthcare systems, and participate in quality and patient safety activities. We suggest that a developmental trajectory for systems thinking be developed, similar to the model described by Dreyfus and Dreyfus.
authors.affiliation: Scott & White Healthcare and Internal Medicine, Texas A&M University System Health Science Center College of Medicine, Temple, Texas 76508, USA. cycolbert@swmail.sw.org
authors.forename: Colleen Y
authors.initials: CY
authors.lastname: Colbert
authors.forename: Paul E
authors.initials: PE
authors.lastname: Ogden
authors.forename: Allison R
authors.initials: AR
authors.lastname: Ownby
authors.forename: Constance
authors.initials: C
authors.lastname: Bowe
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D003695:Delivery of Health Care; D004503:Education, Medical, Graduate; D006801:Humans; D011594:Psychometrics; D013597:Systems Analysis