A Systematic Review on the Effectiveness of Systems-Based Practice Curricula in Health Professions Education

Abstract

This systematic review aims to evaluate the effectiveness of systems-based practice (SBP) curricula from the perspective of health professions students and workers. A total of 8468 citations were sourced from six electronic databases and manual searches conducted independently by two researchers, of which 44 studies were eventually included. A meta-analysis using a random effects model and a meta-synthesis using the thematic synthesis approach were conducted. Most studies targeted medical students, residents, and resident physicians from various clinical specialties. Almost half of all studies focused on didactic or knowledge-based interventions to teach SBP. About a third of all studies measured non-self-evaluated knowledge change, clinical abilities, and clinical outcomes. Both meta-analysis and meta-synthesis results revealed positive outcomes of increased knowledge of SBP, increased recognition of SBP as a core competency in one’s profession, and increased application of SBP knowledge in one’s profession. Meta-synthesis results also revealed negative outcomes at the institutional and teacher/health professions level. This review highlights the importance of SBP education and supports the effectiveness of SBP curricula. There is a need to address the negative outcomes at the institutional and teacher/health professions level. Moreover, future studies could investigate the integration of self-assessment outcomes with comparison to some external standard.

Systems-Based Practice in Graduate Medical Education: Evolving Toward an Ideal Future State

“…Checkbox mentalities, focused on satisfying regulatory requirements, have resulted in SBP courses that are disconnected from the practical reality of medical learners, who often struggle with a lack of SBP role models among faculty members 15 . A recent review suggests that, while some promising advances in SBP knowledge and application have been demonstrated, 2 there were also perceptions that SBP teaching has eroded the amount of curricular time available for more medically focused competencies 16 . Moreover, that same review suggests that SBP was not always viewed as relevant for some practice contexts and was not introduced early enough in training 2 …”

“…A recent review suggests that, while some promising advances in SBP knowledge and application have been demonstrated, 2 there were also perceptions that SBP teaching has eroded the amount of curricular time available for more medically focused competencies 16 . Moreover, that same review suggests that SBP was not always viewed as relevant for some practice contexts and was not introduced early enough in training 2 …”

“…12,13 A recent systematic review identified 44 published SBP curricula, with studies demonstrating positive outcomes with respect to trainees' increased knowledge of SBP, perceptions of SBP as a core competency, and ability to apply SBP knowledge in practice. 2 Over time, and despite efforts to redefine and co-construct SBP competencies, there have also been well-documented stumbling blocks. 3,10,14 Checkbox mentalities, focused on satisfying regulatory requirements, have resulted in SBP courses that are disconnected from the practical reality of medical learners, who often struggle with a lack of SBP role models among faculty members.…”

“…16 Moreover, that same review suggests that SBP was not always viewed as relevant for some practice contexts and was not introduced early enough in training. 2 There have also been challenges with SBP implementation. 17,18 For instance, SBP implementation has not adequately incorporated health equity and structural competency (i.e., the ability to understand structures and systems).…”

“…Systems-based practice (SBP) was first introduced as a core competency in graduate medical education (GME) in 2002 by the Accreditation Council for Graduate Medical Education (ACGME) as part of the Outcomes Project 1 . While inclusion of SBP content in GME has become increasingly common, 2 there have also been well-documented stumbling blocks, 3 including perceptions that SBP has eroded the amount of curricular time available for more medically focused competencies, is not relevant for some practice contexts, and is not introduced early enough in training. As a result, SBP learning experiences often feel disconnected from medical trainees’ practical reality.…”