A Qualitative Study of the Systems-Based Practice Competency in United States Graduate Medical Education

Background Systems-based practice (SBP) is a core competency in U.S. graduate medical education (GME), but it is not well implemented; we examined current factors that need to be addressed to advance SBP. Methods  Between March and July 2021, 24 physicians, nurses, educators, and leaders in the field of SBP were interviewed using a semi-structured guide. Individuals were selected based on their influence on the origin or development of SBP. The authors iteratively collected and analyzed data using real-time analytic memos, regular adjudication sessions, and thematic analysis. Themes were agreed upon by the research team. Results  Four themes were identified: (1) co-production is a central concept in the implementation of SBP, (2) co-production needs to occur between multiple stakeholders across a multitude of settings, (3) health organizations need to transform into learning health organizations to advance SBP, and (4) macrosystem-level fragmentation and organizational culture are inhibiting SBP in healthcare delivery. Conclusions The ability of GME programs to successfully implement SBP is closely tied to their ability to collaborate with their local health systems and have those health systems actively support SBP principles. Co-production and transformation into learning health systems are two key strategies for achieving optimized SBP.