Ask the expert: What are the elements of the practice-based learning and improvement (PBLI) competency?

Residency Program Insider, May 25, 2010

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There are six task areas of PBLI competence. They are the following.

  • System improvement involves measuring performance in practice and redesigning care delivery processes and systems to improve care. Tightly linked to the competency of systems-based practice, this element of PBLI acknowledges that the quality of healthcare depends not solely on the knowledge and skills of a physician, but on the coordinated and standardized work of a team of staff members and professionals. This is a new concept for physician practice and education, and it may be the most important component of PBLI.
  • Knowledge management (KM) is the second element of PBLI competency. Traditionally, KM involved searching for published information in library collections and online databases, but KM has come to mean much more. It encompasses a broader perspective on the nature of medical knowledge (separate competency) as being more than the acquisition, assimilation, and analysis of the scientifically based explicit knowledge published in the medical literature. It involves capturing and transmitting knowledge learned through practice. It is the essence of PBLI.
  • Population health is the third element of PBLI. Population health is the analysis and assessment of health outcomes of a group of individuals (e.g., the population of patients seeking care from an individual practice), including how those outcomes are dispersed across the group. The principles and practice of public health underpin measurement of quality and system improvement. By incorporating principles of population health into the competency of PBLI, we bring an awareness of how the individual physician can help improve the health of an entire population, such as the community in which he or she practices.
  • Evidence-based medicine (EBM) is the disciplined habit of PBLI wherein the physician applies the highest-quality evidence obtained from the scientific method to make medical decisions about different diagnostic or therapeutic strategies.
  • Medical informatics involves the use of systems to facilitate the acquisition, storage, and utilization of healthcare information. The practical elements of medical informatics for the clinician involve knowledge and skill in using an electronic health record, templates for systematically recording standardized data, embedded decision support tools, patient care registries, and health information exchanges. Medical informatics provides powerful tools for KM, incorporating evidence-based medicine into decision support at the point of care, and connecting clinicians and patients with each other through electronic communication.
  • Healthcare education ties up the loose ends in this complex competence. It is a component of KM that entails the human dimensions of transferring knowledge and technical skill to novice and advanced beginner members of the healthcare team. It involves the training and education needed to implement changes in care processes and to adapt new knowledge and techniques into the healthcare processes. This includes teaching junior members of the profession as well as engaging in collaborative learning with other professionals. This element highlights the importance of viewing the clinical microsystem as a learning organization.

This week’s question and answer are adapted from HCPro’s newest residency resource, A Practical Guide to Teaching and Assessing the ACGME Core Competencies, Second Edition. Available now.


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