Exploring clinician perspectives of systems-based practice: A physician training challenge

Area of Science:

• Medical Education
• Health Systems Science
• Healthcare Professional Development

Background:

• Systems-based practice (SBP) has been a required competency in US graduate medical education for over two decades.
• Despite its long-standing presence, SBP remains poorly implemented and loosely defined.
• This study explores healthcare professionals' perspectives on SBP knowledge, beliefs, and the factors influencing its learning and application within clinical learning environments (CLE).

Purpose of the Study:

• To describe healthcare professionals' knowledge and beliefs about Systems-based practice (SBP).
• To identify factors within clinical learning environments (CLE) that facilitate or hinder the operationalization and learning of SBP.
• To inform strategies for improving SBP implementation in graduate medical education.

Main Methods:

• Semi-structured interviews were conducted with 42 healthcare professionals across four health systems.
• Participants included physicians and interprofessional clinicians involved in graduate medical education.
• A social constructivist, codebook thematic analysis approach was used to analyze interview transcripts.

Main Results:

• SBP is challenging to define but may be intuitively understood at the microsystem level.
• SBP aligns with the Health Systems Science framework.
• Intentional integration of SBP training (e.g., onboarding) and multidisciplinary settings are crucial for learning; workload compression is a barrier.

Conclusions:

• Current clinical learning environments (CLEs) do not prioritize Systems-based practice (SBP).
• Graduate medical education programs should focus SBP content at the microsystem level.
• Integrating SBP into onboarding, clinical settings, and rotations is recommended for effective residency training.