title: Systems-Oriented Workplace Learning Experiences for Early Learners: Three Models.
abstract: Early workplace learning experiences may be effective for learning systems-based practice. This study explores systems-oriented workplace learning experiences (SOWLEs) for early learners to suggest a framework for their development.
  
  
  
  The authors used a two-phase qualitative case study design. In Phase 1 (spring 2014), they prepared case write-ups based on transcribed interviews from 10 SOWLE leaders at the authors' institution and, through comparative analysis of cases, identified three SOWLE models. In Phase 2 (summer 2014), studying seven 8-week SOWLE pilots, the authors used interview and observational data collected from the seven participating medical students, two pharmacy students, and site leaders to construct case write-ups of each pilot and to verify and elaborate the models.
  
  
  
  In Model 1, students performed specific patient care activities that addressed a system gap. Some site leaders helped students connect the activities to larger systems problems and potential improvements. In Model 2, students participated in predetermined systems improvement (SI) projects, gaining experience in the improvement process. Site leaders had experience in SI and often had significant roles in the projects. In Model 3, students worked with key stakeholders to develop a project and conduct a small test of change. They experienced most elements of an improvement cycle. Site leaders often had experience with SI and knew how to guide and support students' learning.
  
  
  
  Each model could offer systems-oriented learning opportunities provided that key elements are in place including site leaders facile in SI concepts and able to guide students in SOWLE activities.
authors.affiliation: B.C. O'Brien is associate professor, Department of Medicine, and research faculty member, Office of Research and Development in Medical Education, University of California, San Francisco, School of Medicine, San Francisco, California. M.R. Bachhuber is associate clinical professor, Department of Medicine, University of California, San Francisco, and deputy associate chief of staff for education, San Francisco VA Medical Center, San Francisco, California. A. Teherani is professor, Department of Medicine, and research faculty member, Office of Research and Development in Medical Education, University of California, San Francisco, School of Medicine, San Francisco, California. T.M. Iker was research assistant, Office of Research and Development in Medical Education, University of California, San Francisco, School of Medicine, San Francisco, California, at the time this work was completed. J. Batt is clinical research coordinator, Department of Nephrology, University of California, San Francisco, San Francisco, California. P.S. O'Sullivan is professor, Department of Medicine and Surgery, and director, Office of Research and Development in Medical Education, University of California, San Francisco, School of Medicine, San Francisco, California.
authors.forename: Bridget C
authors.initials: BC
authors.lastname: O'Brien
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Bachhuber
authors.forename: Arianne
authors.initials: A
authors.lastname: Teherani
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Iker
authors.forename: Joanne
authors.initials: J
authors.lastname: Batt
authors.forename: Patricia S
authors.initials: PS
authors.lastname: O'Sullivan
mesh_terms: D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004512:Education, Pharmacy / Q000379:methods*; D006801:Humans; D007858:Learning; D010865:Pilot Projects; D036301:Qualitative Research; D058996:Quality Improvement; D013337:Students, Medical; D013339:Students, Pharmacy; D013597:Systems Analysis; D017132:Workplace