Systems-Based Practice: Expert Perspectives on the Origin and Evolution of an Ambiguous Competency.

Area of Science:

• Medical Education
• Graduate Medical Education
• Healthcare Systems

Background:

• Systems-based practice (SBP) is a core competency in U.S. graduate medical education since 1999.
• Conceptual ambiguity has hindered SBP operationalization in residency programs.
• Understanding the historical development of SBP is crucial for its effective implementation.

Purpose of the Study:

• To explore the historical origin and development of the SBP competency.
• To gather insights from influential individuals in SBP's implementation and evolution.
• To inform the current construct of SBP through historical expert perspectives.

Main Methods:

• Conducted semistructured interviews with 24 physicians, nurses, educators, and leaders in SBP (March-July 2021).
• Selected participants based on their influence on the origin or evolution of the SBP competency.
• Employed thematic analysis with iterative data collection, analytic memos, and adjudication sessions.

Main Results:

• Identified five key themes regarding SBP.
• SBP possesses diverse definitions and was intentionally designed with some vagueness.
• Systems thinking underpins SBP; it's interdependent with other core competencies, particularly practice-based learning and improvement.

Conclusions:

• SBP is a nuanced and complex competency with a lack of shared understanding among stakeholders.
• Historical examination of expert perspectives offers insights for improving SBP education and learning.
• Addressing the ambiguity and interdependencies of SBP is key for enhancing its teaching and application.