title: Reshaping orthopaedic resident education in systems-based practice.
abstract: BACKGROUND
  Despite advances in understanding the "systems-based practice" competency in resident education, this topic has remained difficult to teach, assess, and document. The goal of this study was to perform a needs assessment and an analysis of the current state of systems-based practice education in orthopaedic residency programs across the U.S. and within our own institution.
  
  
  METHODS
  A sample of orthopaedic educators and residents from across the U.S. who were attending the 2010 American Orthopaedic Association (AOA) Effective Orthopaedic Educator Course, AOA Resident Leadership Forum, and AOA Council of Residency Directors meeting were surveyed to determine (1) which aspects of systems-based practice, if any, were being taught; (2) how systems-based practice is being taught; and (3) how residency programs are assessing systems-based practice. In addition, an in-depth case study of these issues was performed by means of seven semi-structured focus group sessions with diverse stakeholders who participated in the care of musculoskeletal patients at the authors' institution. A quantitative approach was used to analyze the survey data. The focus group data were analyzed with procedures associated with grounded theory, relying on a constant comparative method to develop salient themes arising from the discussion.
  
  
  RESULTS
  "Clinical observation" (33%) and "didactic case-based learning" (23%) were reported by the survey respondents as the most commonly used teaching methods, but specific topics were taught inconsistently. Competency assessment was reported to occur infrequently, and 36% of respondents reported that systems-based practice areas were not being assessed by any methods. The focus group discussions emphasized the need for standardized experiential learning that was closely linked to the patient's perspective. Orthopaedic faculty members were uncomfortable with their knowledge of this competency and their ability to teach and assess it.
  
  
  CONCLUSIONS
  Teaching the systems-based practice competency occurs inconsistently, and formal assessment occurs infrequently. In addition to formal teaching, learning systems-based practice will be best achieved experientially and from the patient's perspective.
authors.affiliation: Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Susanne M
authors.initials: SM
authors.lastname: Roberts
authors.forename: Sandra
authors.initials: S
authors.lastname: Jarvis-Selinger
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Pratt
authors.forename: Andrea
authors.initials: A
authors.lastname: Polonijo
authors.forename: Andrea
authors.initials: A
authors.lastname: Polinijo
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stacy
authors.forename: Katherine
authors.initials: K
authors.lastname: Wisener
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Black
mesh_terms: D003162:Competency-Based Education / Q000639:trends*; D003226:Congresses as Topic; D004502:Education, Medical, Continuing / Q000639:trends*; D017144:Focus Groups; D006801:Humans; D007396:Internship and Residency; D020380:Needs Assessment; D009985:Orthopedics / Q000193:education*; D014481:United States