BACKGROUND: When mandated as resident competencies in 1999, systems-based practice (SBP) and practicebased learning and improvement (PBLI) were new concepts to many.
OBJECTIVE:To describe and evaluate a 4-week clinical elective (Achieving Competence Today-ACT) to teach residents SBP and PBLI.DESIGN: ACT consisted of a four-week active learning course and follow-up teaching experience, guided and supported by web-based materials. The curriculum included readings, scheduled activities, work products including an improvement project, and weekly meetings with a non-expert preceptor. The evaluation used a before-after cross-comparison of ACT residents and their peers.
RESULTS AND MAIN MEASUREMENTS:All residents and faculty preceptors responded to a knowledge test, survey of attitudes, and self-assessment of competency to do 15 tasks related to SBP/PBLI. All measures were normalized to a 100-point scale. Each program's principal investigator (PI) identified aspects of ACT that were most and least effective in enhancing resident learning. ACT residents' gains in knowledge (4.4 on a 100-point scale) and self-assessed competency (11.3) were greater than controls' (−1.9, −8.0), but changes in attitudes were not significantly different. Faculty preceptors' knowledge scores did not change, but their attitudes became more positive (15.8). PIs found a ready-to-use curriculum effective (rated 8.5 on a 10-point scale).
CONCLUSIONS:ACT increased residents' knowledge and self-assessment of their own competency and raised faculty's assessment of the importance of residents' learning SBP/PBLI. Faculty content expertise is not required for residents to learn SBP/PBLI.
INTRODUCTIONIn 1999, the Accreditation Council for Graduate Medical Education (ACGME) instituted a radical change in the way it accredited residency programs in the United States. It defined 6 competency goals that all residents should meet, 2 of whichSystems-Based Practice (SBP) and Practice-Based Learning and Improvement (PBLI) 1 -reflected the ACGME's conviction that medical graduates need to understand the system in which they practice and to apply systematic methods to identify and address system problems.When faced with integrating new curricular content into any training program, educators may encounter several impediments: programs may already be saturated with equally important content; stakeholders may not understand the new content or perceive its importance; and there may be a shortage of faculty experts to teach the new content.
2,3To overcome these problems, we designed a program-Achieving Competence Today (ACT) -to help residency programs teach SBP/PBLI and develop new SBP/PBLI curricula. The design of ACT addresses the challenges mentioned above by: (a) creating a self-directed, web-based curriculum that eliminates the need for expert faculty but also trains faculty, (b) developing learning activities to be carried out in the local clinical setting with learners' own patients, and (c) engaging learners in teaching and curriculum development in collabo...