“…With the development of specific competencies for graduate medical education by the Accreditation Council for Graduate Medical Education (ACGME; ACGME, 2008) and the more recent passage of the ACA (Sommers & Bindman, 2012), physicians who are able to effectively practice within the context and constraints of a health care system are critical. Though much has been written about these systems-based practice skills and how medical schools could teach them (Barffour, Gupta, Gururaj, & Hyder, 2012;Brandon & Mullan, 2013;Carey & Colby, 2013;Chen, O'Sullivan, Pfennig, Leone, & Kessler, 2012;Dunn, Dalton, Dorfman, & Dunn, 2004;Gillen et al, 2013;Hankins et al, 2001;Kanthan & Senger, 2011;Kronz, Westra, & Epstein, 1999;LeMelle, Arbuckle, & Ranz, 2013;McGinty, Larson, Hodas, Musick, & Metz, 2012;Roberts, Jarvis-Selinger, Pratt, Lucking, & Black, 2013;Roberts et al, 2012;Sheu, O'Brien, O'Sullivan, Kwong, & Lai, 2013;Szymczak & Bosk, 2012), the recent increased focus on health care systems provides ample rationale for additional study. In this research, the overall problem was to analyze medical student reflective writings to explore how the focus of a medical student progresses through the clinical curriculum.…”