Systems-based practice: the sixth core competency

Area of Science:

• Medical Education
• Healthcare Systems Management
• Emergency Medicine

Background:

• The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project defines Systems-Based Practice (SBP) as a core competency.
• SBP emphasizes resident awareness of healthcare systems and effective resource utilization for optimal patient care value.
• SBP encompasses four subcompetencies vital for emergency medicine (EM) physicians: resources, providers, systems, cost-appropriate care, delivery systems, and patient advocacy.

Purpose of the Study:

• To modify the ACGME SBP competency for emergency medicine residency training.
• To define EM-specific goals and objectives for SBP training.
• To identify primary assessment methods and relevant physician tasks for SBP in EM.

Main Methods:

• A consensus conference convened by the Council of Emergency Medicine Residency Directors (CORD-EM) in March 2002.
• Modification of the broad ACGME SBP definition into EM-specific goals and objectives.
• Identification of primary assessment methods (direct observation, global ratings, 360-degree evaluations, portfolio assessment, oral/written exams) and relevant physician tasks.

Main Results:

• The Consensus Group successfully modified the SBP competency for EM training.
• Key physician tasks relevant to SBP in EM were identified, including out-of-hospital care, cost-appropriate care, and team management.
• Existing EM residency curriculum components, such as EMS rotations and quality improvement projects, can be leveraged for SBP training.

Conclusions:

• The modified SBP competency provides a framework for training EM physicians in systems-based practice.
• Integration and evaluation of SBP within residency programs are essential for future healthcare improvements.
• Well-defined outcomes and a systemic healthcare view benefit both physicians and patients.