Systems-Based Practice Defined: Taxonomy Development and Role Identification for Competency Assessment of Residents

Graham, Mark; Naqvi, Zoon; Encandela, John; Harding, Kelli J.; Chatterji, Madhabi

doi:10.4300/01.01.0009

Cited by 38 publications

(33 citation statements)

References 21 publications

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“…19 While there is acknowledged conceptual legitimacy of the construct ''competencies'', 78-80 the key issue is that attempts to apply these to teaching and evaluation may create problems for evaluators for whom these deconstructed elements appear unrelated to the complex and frequently indiscernible ways they are integrated into clinical practice. 78,85,86 This is particularly true when the residents under observation have moved past the Dreyfuss' levels of ''novice'' and ''advanced beginner'' to ''competent'' and ''proficient.'' At these stages, learners deal simultaneously with multiple activities and accumulated information; they begin to take a holistic view of situations and perceive deviations from the normal pattern.…”

Section: Embedding the Competencies In Resident Teaching And Evaluationmentioning

confidence: 99%

Review article: Closing the research gap at the interface of learning and clinical practice

Philibert

2011

Can J Anesth/J Can Anesth

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Purpose The dialogue at the interface of education and clinical practice highlights areas of critical importance to the development of new approaches for educating anesthesiologists. The purpose of this article is to examine the literature on education and acquisition of competence in three areas relevant to the interface of learning and clinical practice, with the aim to suggest a research agenda that adds to the evidence on preparing physicians for independent practice. The three areas are: 1) transitions across the continuum of education; 2) the effect of reductions in hours of clinical training on competence; and 3) efforts to incorporate the competencies and CanMEDS roles into teaching and evaluation. Principal findings Fifty-six articles relevant to one or more of the themes were identified in the review, including 21 studies of transitions (in, during, and after residency education), 19 studies on the effects of duty hour limits on residents' acquisition of competence, and 16 articles that assessed competency-based teaching and assessment in anesthesiology. Overall, the findings suggested a relative paucity of scientific evidence and a need for research and the development of new scientific theory. Studies generally treated one of the themes in isolation, while in actuality they interact to produce optimal as well as suboptimal learning situations, while medical education research often is limited by small samples, brief follow-up, and threats to validity. This suggests a ''research gap'' where editorials and commentaries have moved ahead of an evidence base for education. Promising areas for research include preparation for care deemed important by society, work to apply knowledge about the development of expertise in other disciplines to medicine, and ways to embed the competencies in teaching and evaluation more effectively. Conclusion Closing the research gap in medical education will require clear direction for future work. The starting point, at an institution or nationally, is dialogue within the specialty to achieve consensus on some of the most pressing questions.

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Section: Embedding the Competencies In Resident Teaching And Evaluationmentioning

confidence: 99%

Review article: Closing the research gap at the interface of learning and clinical practice

Philibert

2011

Can J Anesth/J Can Anesth

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“…In a recent commentary, Batalden and Leach 10 note that it is time to stop ''protecting'' our trainees from the ''system,'' but rather that ''It is time to incorporate mastery of systems as part of the educational agenda; the well-being of both patients and doctors depends on these skills'' (p. 2). Similarly, Graham et al 11 suggest developing a formalized taxonomy for SBP education, although actual concrete examples of measuring progress are limited, and existing tools run the risk of measurement pitfalls later. Though we hesitate to admit it, cost is a driving factor of many medical decisions.…”

Section: Development Of An Education and Assessment Toolmentioning

confidence: 99%

“…Englander and colleagues 18 have shown the true potential of SBP cost-based education with an estimated savings per year of over $500 000 to their health care system following implementation of a program that taught pediatric residents the economic differences between laboratory and point-ofcare testing. More recently, Graham and colleagues 11 have suggested an SBP taxonomy with the resident filling multiple roles in the greater health care setting, including that of ''resource manager,'' requiring the trainee to demonstrate cost-effective practice by performing costbenefit analyses, using resources appropriately, and providing quality assurance based on appropriate resource allocation.…”

Section: Systems-based Practice In Anesthesiology Educationmentioning

confidence: 99%

Teaching Systems-Based Competency in Anesthesiology Residency: Development of an Education and Assessment Tool

Soto¹,

Cormican²,

Gallagher³

et al. 2010

Journal of Graduate Medical Education

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Background The Accreditation Council for Graduate Medical Education requires programs to educate and evaluate residents in 6 competencies, including systems-based practice. We designed a survey and assessment tool to address the competency as it pertains to anesthetic drug costs in an academic center. Methods Residents, certified registered nurse anesthetists, and faculty were asked to complete an anesthetic drug-cost survey without relying on reference materials. After a combination of compulsory in-class didactic sessions and web-based education, the participants were asked to design an anesthetic, give example cases, and determine costs. The initial task was repeated 1 year later. Results Our preintervention survey revealed that most practitioners knew very little about anesthetic drug costs, regardless of level of training or degree. All residents completed the mandatory online education tool, more than 80% attended the departmental grand rounds program, and 100% met the goal of designing an anesthetic for all cases within the preset price limit. A repeat of the cost estimate produced an improvement in cost estimates with reduction in variability (P < .05, Student unpaired t test), although estimates of volatile anesthetic and reversal agent costs did not achieve significance at the .05 level for any of the 3 cases. Conclusion Introducing a formalized teaching and assessment tool has improved our residents' understanding of anesthetic drug costs, and improved our ability to teach and assess the systems-based practice competency.

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“…Many emphasize the need for a system-based approach in healthcare in which the patient has a central role [11,12]. A systembased approach is defined as: the demonstration of "an awareness of and responsiveness to the larger context and system of healthcare and the ability to effectively call on system resources to provide care that is of optimal value."…”

Section: Introductionmentioning

confidence: 99%

“…A systembased approach is defined as: the demonstration of "an awareness of and responsiveness to the larger context and system of healthcare and the ability to effectively call on system resources to provide care that is of optimal value." [13] This system-based approach would facilitate physicians to move competently within the larger systems of care providing interdisciplinary, coordinated, and safe care [11], the main focus in this approach being the patient [3,14]. The healthcare professional should learn to read the medical case stories from a patient point of view.…”

Section: Introductionmentioning

confidence: 99%

Improving transitional patient safety: research protocol of the Transitional Incident Prevention Programme

Melle

Zwart

Bont³

et al. 2015

Saf Health

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Introduction: Patient transitions between primary and hospital care include referral, discharge, and simultaneous care by the outpatient clinic and the general practitioner (GP). Research on referrals and discharge shows that safety incidents in these transitions are common. We developed the multifaceted Transitional Incident Prevention Programme (TIPP), which aims to improve transitional patient safety preventing future incidents. With this study, we aim to evaluate the effectiveness of the TIPP programme on transitional patient safety, and to evaluate its implementation and the acceptance in GP-practices and hospitals. Methods: The TIPP intervention study is a controlled before and after study combined with qualitative methods. The study will be conducted in both rural and urban settings including three hospitals, together with referring primary care practices. The TIPP intervention is aimed at three aspects of transitional safety: 1) Healthcare process, 2) Transitional patient safety culture, and 3) Patient participation. Together with the participating hospital departments, GPs and patients, we will develop a tailored improvement programme, taking into account the different context of each setting.

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Systems-Based Practice Defined: Taxonomy Development and Role Identification for Competency Assessment of Residents

Cited by 38 publications

References 21 publications

Review article: Closing the research gap at the interface of learning and clinical practice

Review article: Closing the research gap at the interface of learning and clinical practice

Teaching Systems-Based Competency in Anesthesiology Residency: Development of an Education and Assessment Tool

Improving transitional patient safety: research protocol of the Transitional Incident Prevention Programme

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