Ask the expert: What are the subcompetencies of practice-based learning and improvement?

Residency Program Insider, November 2, 2010

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There are six task areas of PBLI competence. These tasks are loosely tied together within this new competency:

1. 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, 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.

2. Knowledge management is the second element of PBLI competency. It encompasses a broader perspective 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. Instead, it involves capturing and transmitting knowledge learned through practice. It is the essence of PBLI.

Knowledge management developed into a discipline comprising a range of strategies and practices used by individuals and organizations to identify and facilitate adoption of employees’ insights and experiences.

In clinical medicine, knowledge management explicitly identifies the process of practice-based learning by capturing the insights from everyday practice, and by understanding the exceptions clinicians make when protocols or the evidence doesn’t apply to particular patient situations. Knowledge management captures the successes and failures of rapid-cycle tests of process changes aimed at improving care, thus linking to the system improvement component of PBLI.

3. 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.

Population health seeks to step beyond the individual-level focus of clinical medicine and public health by addressing a broad range of factors that affect health on a population level, such as environment, social structure, and resource distribution. By incorporating principles of population health into the competency of PBLI, educators 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.

4. Evidence-based medicine is the disciplined habit of PBLI wherein the physician applies the highest-quality evidence from the scientific method to make medical decisions about different diagnostic or therapeutic strategies. This element involves:

  • Formulating a clinical question
  • Locating scientific evidence that may answer the question
  • Analyzing the veracity of the evidence to make a cogent judgment about actions to be taken

5. Medical informatics involves the use of systems to facilitate the acquisition, storage, and utilization of healthcare information. Physicians commonly use smart phones, computer software, and publications, such as practice or clinical guidelines.

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. It also helps physicians understand the importance of standards in information management.

Medical informatics provides powerful tools for knowledge management, incorporating  evidence-based medicine into decision support at the point of care, and connecting clinicians and patients through electronic communication.

6. Healthcare education ties up the loose ends in this complex competence. It is a component of knowledge management 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 for implementing changes in care processes and adapting 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.

Today’s question and answer are from A Practical Guide to Teaching and Assessing the ACGME Core Competencies.

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