title: Putting residents in the office: an effective method to teach the systems-based practice competency.
abstract: OBJECTIVE
  Systems-based practice (SBP) was 1 of 6 core competencies established by the Accreditation Council for Graduate Medical Education and has proven to be one of the most difficult to effectively implement. This pilot study presents an immersion workshop as an effective tool to teach the SBP competency in a way that could easily be integrated into a residency curriculum.
  
  
  METHODS
  In 2006, 16 surgical residents rotated through 3 stations for 30 minutes each: coding and billing, scheduling operations and return appointments, and patient check-in. Participants were administered a pretest and posttest questionnaire evaluating their knowledge of SBP, and were asked to evaluate the workshop.
  
  
  METHODS
  Outpatient clinic at MedStar Georgetown University Hospital, Washington, DC.
  
  
  METHODS
  Residents in the general surgery residency training program at MedStar Georgetown University Hospital.
  
  
  RESULTS
  Most residents (62.5%) improved their score after the workshop, whereas 31.25% showed no change and 6.25% demonstrated a decrease in score. Overall within their training levels, all groups demonstrated an increase in mean test score. Postgraduate year-2 residents demonstrated the greatest change in mean score (20%), whereas postgraduate year-4 residents demonstrated the smallest change in mean score (3.3%).
  
  
  CONCLUSIONS
  An immersion workshop where general surgery residents gained direct exposure to SBP concepts in situ was an effective and practical method of integrating this core competency into the residency curriculum. Such a workshop could complement more formal didactic teaching and be easily incorporated into the curriculum. For example, this workshop could be integrated into the ambulatory care requirement that each resident must fulfill as part of their clinical training.
authors.affiliation: Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia.
authors.forename: Marisa
authors.initials: M
authors.lastname: Pulcrano
authors.affiliation: Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia; Department of Surgery, Children's National Health System, Washington, District of Columbia. Electronic address: achahine@childrensnational.org.
authors.forename: A Alfred
authors.initials: AA
authors.lastname: Chahine
authors.affiliation: Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Saratsis
authors.affiliation: Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia.
authors.forename: Jamie
authors.initials: J
authors.lastname: Divine-Cadavid
authors.affiliation: Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia.
authors.forename: Vinod
authors.initials: V
authors.lastname: Narra
authors.affiliation: Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia.
authors.forename: Stephen R T
authors.initials: SR
authors.lastname: Evans
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D001071:Appointments and Schedules; D002983:Clinical Competence; D003162:Competency-Based Education / Q000458:organization & administration; D004219:District of Columbia; D004503:Education, Medical, Graduate / Q000379:methods / Q000458:organization & administration; D005260:Female; D013502:General Surgery / Q000193:education*; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency / Q000379:methods* / Q000458:organization & administration*; D008297:Male; D009817:Office Management / Q000458:organization & administration*; D010865:Pilot Projects; D018794:Problem-Based Learning / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation
keywords: Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; competencies; general surgery residency; graduate medical education; systems-based practice