Residency

Teach practice-based learning and improvement

Residency Program Insider, February 27, 2007

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Teach practice-based learning and improvment

According to the Accreditation Council for Graduate Medical Education, residents must be able to investigate, evaluate, and improve their patient care practices and appraise and assimilate scientific evidence in order to achieve competency in Practice-Based Learning and Improvement (PBLI).

Residents are expected to:

  • analyze practice experience and perform practice-based improvement activities using a systematic methodology
  • locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems
  • obtain and use information about their own population of patients and the larger population from which their patients are drawn
  • apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness
  • use information technology to manage information, access on-line medical information; and support their own education
  • facilitate the learning of students and other health care professionals

    PBLI and the other competencies are benchmarks in the professional development of physicians, a major component of which is residency.

    PBLI can be described in terms of categories of behavior, including:

    1. Practice tracking and analysis
    2. Ongoing learning
    3. Improvement

    These categories of behaviors are interrelated; for instance, a physician is more likely to improve if he or she recognizes aspects of his or her practice that could be better.

    There are also basic knowledge and skills required for PBLI. Residents should understand:

  • how to reflect and self-assess
  • evidence-based medicine databases
  • how to use technology to locate databases and manage information
  • methods for studying populations and how to apply them
  • how to do outcome-based measurement
  • improvement tools and how to apply them
  • research methodologies and statistics

    PBLI can be applied in a wide variety of approaches and circumstances. Keep in mind that the importance of PBLI lies in the evidence that learning steps are occurring and new knowledge, skills and values are being manifested. The following are some approaches to teaching PBLI:

  • checklist
  • morbidity and mortality conferences
  • small group learning program
  • evidence-based medicine (integration of research evidence with clinical experience)
  • logs of significant events or clinical surprises
  • medical records review
  • quality Improvement projects

    Editor's Note: The above information is a summarized excerpt from the PBLI chapter of the upcoming book, A Practical Guide to Teaching and Assessing the ACGME Core Competencies. The book includes strategies, tips, and assessment methods for all six core competencies, and is authored by Elizabeth Rider, MSW, MD, FAAP, Gary Smith, Ed.D, and Ruth Nawotniak, MS, CTAGME. A Practical Guide to Teaching and Assessing the ACGME Core Competencies will be published in April.

    All the best,


    Gary Smith, Ed.D.
    Administrative director
    John Peter Smith Hospital
    University of North Texas Health Science Center
    Fort Worth, TX



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