title: An alternative practice model: residents transform continuity clinic and become systems thinkers.
abstract: BACKGROUND
  A changing health care environment has created a need for physicians trained in health system improvement. Residency programs have struggled to teach and assess practice-based learning and improvement and systems-based practice competencies, particularly within ambulatory settings.
  
  
  METHODS
  We describe a resident-created and resident-led quality and practice-improvement council in an internal medicine continuity clinic. We conducted focus groups and report on residents' perspectives on council membership, practice management experiences, quality improvement projects, and resident satisfaction.
  
  
  METHODS
  Focus groups were held from May 2009 to March 2010 with internal medicine residents (N  =  5/focus group) who participated in the Continuity Clinic Ownership in Resident Education (CCORE) council. Data were analyzed with a grounded theory approach.
  
  
  RESULTS
  DURING THE FOCUS GROUPS, RESIDENTS RESPONDED TO THE QUESTION: "Do you have any new insights into delivering quality patient care in an outpatient clinic as a result of this experience (CCORE membership)?" The qualitative analysis resulted in 6 themes: systems thinking and systems-based care skills; improving quality of patient care; improved clinic efficiency; ownership of patients; need for improved communication of practice changes; and a springboard for research.
  
  
  CONCLUSIONS
  CCORE residents participated in system changes and acquired leadership skills while working on practice-based and system problems in a clinic microsystem. We believe this model can be implemented by other residency programs to promote the development of systems thinking in residents, increase their ownership of continuity clinic, and empower them to implement system changes.
authors.forename: Colleen Y
authors.initials: CY
authors.lastname: Colbert
authors.forename: John D
authors.initials: JD
authors.lastname: Myers
authors.forename: Christian T
authors.initials: CT
authors.lastname: Cable
authors.forename: Paul E
authors.initials: PE
authors.lastname: Ogden
authors.forename: Curtis
authors.initials: C
authors.lastname: Mirkes
authors.forename: Tresa
authors.initials: T
authors.lastname: McNeal
authors.forename: Shawn
authors.initials: S
authors.lastname: Skeen