Perspectives on the changing healthcare system: teaching systems-based practice to medical residents

A Systems-Based Practice Curriculum in Orthopaedics: Successes and Challenges Moving Forward

BACKGROUND

Teaching and assessment of the systems-based practice competency have been a challenge for many educators in graduate medical education. Previous research done at our institution demonstrated a marked inconsistency across institutions in educational content, methods of delivery, and performance assessment. As a result, we developed a 2-week health systems curriculum for orthopaedic surgery residents.

METHODS

A 2-week health systems rotation was developed during which postgraduate year (PGY)-1 residents were excused from their normal clinical duties. Residents followed patients as observers of the health-care system, challenged to view health care through the eyes of the patient and to identify what could be done individually and collectively to provide a better and safer experience. Additional learning experiences were designed on the basis of our literature review. At the end of the rotation, residents discussed and provided a written summary of their experiences and completed an anonymous evaluation. Using a Likert scale (1 to 10), residents were asked if the experience was educational and whether it was it additive to their undergraduate medical education for each of the 9 educational areas.

RESULTS

The mean responses for all 9 educational areas were 8.2 for whether the experience was educational and 8.3 for whether it was it additive to participants' undergraduate medical education. Feedback from residents indicated that they found the course very helpful and that it inspired them to consider how they could "create overdue and necessary changes in our health-care system."

CONCLUSIONS

Our health systems rotation in PGY-1 has been a valuable learning experience for the residents and has created a foundation on which to build in subsequent years of residency.

Personalized Learning in an Online Drugs and US Health Care System Controversies Course

Objective. To examine if personalized learning objectives influenced student engagement and if achievement of objectives could be measured from course assignments. Methods. Learners created personalized learning objectives that correlated with their own goals within the context of the course. Using a mixed-methods analysis approach, the influence of these objectives on engagement and evidence of achievement of objectives were examined. Results. Students reported a positive influence of personalized learning objectives on engagement. Additionally, measurement of student progression or achievement of objectives was possible from analysis of the course assignments. Conclusion. Personalized learning is an important educational design for future pharmacists and health care professionals. Creating personalized learning objectives that build on centralized course objectives and connect to a broader context is one way to achieve the goal of an engaged and expanded learning experience.

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

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.