title: The Action Research Program: Experiential Learning in Systems-Based Practice for First-Year Medical Students.
abstract: OBJECTIVE
  Systems-based practice focuses on the organization, financing, and delivery of medical services. The American Association of Medical Colleges has recommended that systems-based practice be incorporated into medical schools' curricula. However, experiential learning in systems-based practice, including practical strategies to improve the quality and efficiency of clinical care, is often absent from or inconsistently included in medical education.
  
  
  METHODS
  A multidisciplinary clinician and nonclinician faculty team partnered with a cardiology outpatient clinic to design a 9-month clerkship for 1st-year medical students focused on systems-based practice, delivery of clinical care, and strategies to improve the quality and efficiency of clinical operations. The clerkship was called the Action Research Program. In 2013-2014, 8 trainees participated in educational seminars, research activities, and 9-week clinic rotations. A qualitative process and outcome evaluation drew on interviews with students, clinic staff, and supervising physicians, as well as students' detailed field notes.
  
  
  BACKGROUND
  The Action Research Program was developed and implemented at the University of California, San Francisco, an academic medical center in the United States. All educational activities took place at the university's medical school and at the medical center's cardiology outpatient clinic.
  
  
  RESULTS
  Students reported and demonstrated increased understanding of how care delivery systems work, improved clinical skills, growing confidence in interactions with patients, and appreciation for patients' experiences. Clinicians reported increased efficiency at the clinic level and improved performance and job satisfaction among medical assistants as a result of their unprecedented mentoring role with students. Some clinicians felt burdened when students shadowed them and asked questions during interactions with patients. Most student-led improvement projects were not fully implemented.
  
  
  CONCLUSIONS
  The Action Research Program is a small pilot project that demonstrates an innovative pairing of experiential and didactic training in systems-based practice. Lessons learned include the need for dedicated time and faculty support for students' improvement projects, which were the least successful aspect of the program. We recommend that future projects aiming to combine clinical training and quality improvement projects designate distinct blocks of time for trainees to pursue each of these activities independently. In 2014-2015, the University of California, San Francisco School of Medicine incorporated key features of the Action Research Program into the standard curriculum, with plans to build upon this foundation in future curricular innovations.
authors.affiliation: a Department of Social and Behavioral Sciences , University of California, San Francisco , San Francisco , California , USA.
authors.forename: Sara L
authors.initials: SL
authors.lastname: Ackerman
authors.affiliation: b Department of Medicine , University of California, San Francisco , San Francisco , California , USA.
authors.forename: Christy
authors.initials: C
authors.lastname: Boscardin
authors.affiliation: b Department of Medicine , University of California, San Francisco , San Francisco , California , USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Karliner
authors.affiliation: c Department of Epidemiology and Biostatistics , University of California, San Francisco , San Francisco , California , USA.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Handley
authors.affiliation: d University of California , San Francisco School of Medicine , San Francisco , California , USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cheng
authors.affiliation: d University of California , San Francisco School of Medicine , San Francisco , California , USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Gaither
authors.affiliation: d University of California , San Francisco School of Medicine , San Francisco , California , USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Hagey
authors.affiliation: d University of California , San Francisco School of Medicine , San Francisco , California , USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Hennein
authors.affiliation: d University of California , San Francisco School of Medicine , San Francisco , California , USA.
authors.forename: Faizan
authors.initials: F
authors.lastname: Malik
authors.affiliation: d University of California , San Francisco School of Medicine , San Francisco , California , USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Shaw
authors.affiliation: d University of California , San Francisco School of Medicine , San Francisco , California , USA.
authors.forename: Norver
authors.initials: N
authors.lastname: Trinidad
authors.affiliation: d University of California , San Francisco School of Medicine , San Francisco , California , USA.
authors.forename: Greg
authors.initials: G
authors.lastname: Zahner
authors.affiliation: e Department of Medicine , University of California, San Francisco , San Francisco , California , USA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Gonzales
mesh_terms: D002309:Cardiology / Q000193:education*; D002982:Clinical Clerkship; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000639:trends*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008611:Mentors; D018794:Problem-Based Learning; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D014481:United States
keywords: clinical education; implementation science; quality improvement; systems-based practice