Where do we go from here? Moving from systems-based practice process measures to true competency via developmental milestones

Abstract

For many educators it has been challenging to meet the Accreditation Council for Graduate Medical Education's requirements for teaching systems-based practice (SBP). An additional layer of complexity for educators is evaluating competency in SBP, despite milestones and entrustable professional activities (EPAs). In order to address this challenge, the authors present the results of a literature review for how SBP is currently being taught and a series of recommendations on how to achieve competency in SBP for graduate medical trainees with the use of milestones. The literature review included 29 articles and demonstrated that only 28% of the articles taught more than one of the six core principles of SBP in a meaningful way. Only 7% of the articles received the highest grade of A. The authors summarize four guiding principles for creating a competency-based curriculum that is in alignment with the Next Accreditation System (NAS): 1) the curriculum needs to include all of the core principles in that competency, 2) the objectives of the curriculum should be driven by clinical outcomes, 3) the teaching modalities need to be interactive and clinically relevant, and 4) the evaluation process should be able to measure competency and be directly reflective of pertinent milestones and/or EPAs. This literature review and the provided guiding principles can guide other residency educators in their development of competency-based curricula that meets the standards of the NAS.

Expanding the genetic counseling workforce: program directors’ views on increasing the size of genetic counseling graduate programs

“…In the changing landscapes of healthservices delivery models and an increasingly diverse patient population, medical education is moving from systems-based practice to competency-based education. 24,25 Although GCs have been progressive in adapting competency-based training, the current education model also involves intense clinical and research training that requires a tremendous hands-on effort from faculty and has many limitations that prevent a significant increase in class size. Accreditation requirements, especially regarding clinical training, may not always reflect available resources locally or be encouraging to expansion efforts.…”

Systems-Based Practice: Time to Finally Adopt the Orphan Competency

“…2 The definition, performance, training, and evaluation of SBP is considered by many to be the most challenging among the 6 competencies. [3][4][5] Despite the ACGME's introduction of SBP as a core competency more than 20 years ago, with the requirement for SBP teaching and assessment, the published literature suggests that program directors continue to struggle with implementing curricula and assessing residents' competency in this domain. 4 Teaching of the various subcompetencies of SBP is inconsistent and variable across training programs.…”

“…[3][4][5] Despite the ACGME's introduction of SBP as a core competency more than 20 years ago, with the requirement for SBP teaching and assessment, the published literature suggests that program directors continue to struggle with implementing curricula and assessing residents' competency in this domain. 4 Teaching of the various subcompetencies of SBP is inconsistent and variable across training programs. [6][7][8] Many programs rely on passive learning approaches and indirect observation without objective criteria for demonstration of residents' knowledge and skill.…”

Quantification of Entrustable Professional Activities to Evaluate Insight in Learning Progress, A literature Review

“…Underestimating the adequate number of 'units of practice could result in poor performance during assessments. Too many units of practice would not be efficient for both the supervisor and the trainee (Martinez, Phillips and Harris, 2014). Further research needs to be conducted using both qualitative and quantitative data to arrive at the optimal number of units of practice required for each EPA category.…”