Evolving the Systems-Based Practice Competency in Graduate Medical Education to Meet Patient Needs in the 21st-Century Health Care System

Abstract

Medical education is increasingly recognizing the importance of the systems-based practice (SBP) competency in the emerging 21st-century U.S. health care landscape. In the wake of data documenting insufficiencies in care delivery, notably in patient safety and health care disparities, the Accreditation Council for Graduate Medical Education created the SBP competency to address gaps in health outcomes and facilitate the education of trainees to better meet the needs of patients. Despite the introduction of SBP over 20 years ago, efforts to realize its potential have been incomplete and fragmented. Several challenges exist, including difficulty in operationalizing and evaluating SBP in current clinical learning environments. This inconsistent evolution of SBP has compromised the professional development of physicians who are increasingly expected to advance systems of care and actively contribute to improving patient outcomes, patient and care team experience, and costs of care. The authors prioritize 5 areas of focus necessary to further evolve SBP: comprehensive systems-based learning content, a professional development continuum, teaching and assessment methods, clinical learning environments in which SBP is learned and practiced, and professional identity as systems citizens. Accelerating the evolution of SBP in these 5 focus areas will require health system leaders and educators to embrace complexity with a systems thinking mindset, use coproduction between sponsoring health systems and education programs, create new roles to drive alignment of system and educational goals, and use design thinking to propel improvement efforts. The evolution of SBP is essential to cultivate the next generation of collaboratively effective, systems-minded professionals and improve patient outcomes.

Cultivating patient-centered care competence through a telemedicine-based course: An explorative study of undergraduate medical students’ self-reflective writing

“…In addition to provision of primary health care including in consulting the patients on the emergency conditions, the students should be knowledgeable on the referral system in a certain area during the pandemic. The students’ involvement in this telemedicine-based course can be considered as a strategy to provide a clinical learning environment which enables the system-thinking mindset required for future practice ( 39 ). Furthermore, there was also an immense opportunity for students to keep adaptable toward limitation of resources around the patients and their families and overburden of primary health care and hospital care facilities.…”

Implementation and Evaluation of an Interprofessional Health Systems Science Professional Development Program

“…Defined as "the ability to analyze systems as a whole, including the recognition of essential interrelationships within and between subsystems, and any changes and patterns that arise out of the networks of relationships, " 9 systems thinking underlies the Accreditation Council for Graduate Medical Education (ACGME) systems-based practice (SBP) competency and has been identified as the key concept linking domains in the HSS framework. 2 Based on this groundwork, we designed an 8-month (from September to April) longitudinal active learning classroom and project-based curriculum with the goals of improving HSS and teaching skills for application in clinical environments and advancing health for patients served by our health system. Curricular components included 8 hours of synchronous learning sessions each month.…”

“…These competencies comprise the third pillar of medical education, health systems science (HSS), and are meant to prepare health professionals to contribute to the Quadruple Aim. 2 The HSS framework includes competencies related to social determinants of health, population health, interprofessional collaboration, high-value care, and systems thinking.…”

Residency Training in the COVID-19 Pandemic—Addressing the Need for Systems-Based Education

“…3 Progress has been made since that time in piloting initiatives that help residents learn these vital skills, 4 but substantial challenges to further implementation remain. 5 Although the pandemic temporarily stalled the integration of systems-based practices in medical education, it also revealed opportunities to improve residency training 6 and reinvigorate the role that hands-on, real-time learning can have in achieving this core competency. When academic health systems faced unprecedented hospital admissions and rapidly shifting treatment paradigms, frontline residents reliably contributed to improvement endeavors.…”

“…This tenet of education was established as one of the core competencies of the Accreditation Council for Graduate Medical Education (ACGME) in 2001 as a competency-based milestone . Progress has been made since that time in piloting initiatives that help residents learn these vital skills, but substantial challenges to further implementation remain …”