Developing a systems-based practice curriculum

Residency Program Insider, March 13, 2007

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A curriculum should be based upon the "results of a needs assessment, and including goals and objectives developed to meet the identified needs, educational activities through which the plan is implemented, and evaluation of the plan with feedback to provide continued improvement in the educational process," according to the ACGME Web site,

Competency-based education focuses on learner performance in reaching specific objectives. It shifts our focus away from process-oriented measures of education (e.g., how many procedures a resident completed) to outcome-oriented measures (how well the resident completed the procedure).

By including the competency of systems-based practice into the curriculum for training programs, the ACGME is requiring that residents understand the system within which they work. Through the use of feedback and evaluation, the resident can constantly improve and evaluate the way that healthcare needs are met in any given institution. The following groups of systems can be used as a guide to determine which healthcare support services your hospital or institution has available to provide optimal patient care:

  • Healthcare services-in-hospital services and systems such as imaging and lab studies, prescribing medications; patient safety concerns, including communication and resident hand-off procedures; discharge planning, including end-of-life care, home healthcare services, rehabilitation services, therapy services, nursing home services, and assisted living services
  • Healthcare needs-medications, equipment, transportation, nutrition
  • Patient-related concerns-economics and ethnic makeup of the community served; living will requirements; patient-family relationships and responsibility issues
  • The cost of doing business-insurance providers, physician contracts, coding, and office expenses such as equipment and personnel

You may determine these support services by sending surveys to selected people (including nurse managers, discharge planners, and lab service providers) who would list the services that are provided within their area. It could also be done as an activity by a hospital committee that may include representatives of each of the service areas of the hospital. Either of these will give you the breadth and depth of material from which you can then draw upon to develop your teaching points.

Editor's Note: The above information is a summarized excerpt from the systems-based practice 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,

Ruth Nawotniak, MS, C-TAGME
Coordinator, General Surgery Residency Program
University of Buffalo-State University of New York

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