The transformation of graduate medical education is a complex undertaking. It is especially difficult today at a time when academic health centers and GME programs face financial constraints, and when faculty and residents are overloaded with the multiple requirements of practice, research, and training.

THCI recommends the following approach to implementing a curriculum to train residents in System-Based Practice and Practice-Based Learning and Improvement.

1. Define the competencies and outcomes:

• Translate broad goals to specific knowledge and skills.
• Review available reference materials that describe the key drivers in the delivery system and how these impact the roles and responsibilities of physicians.
• Engage the faculty in thinking about their own practices and what skills would help them to be more efficient and effective.
• Read the ACGME competencies and objectives, the RRC program requirements, and other documents written for medical educators to clarify the content that is to be taught.
• Organize the curriculum to present this content. Review the current structure of the year-by-year program in terms of hours, activities, and content. Identify gaps related to the ACGME competencies.
• Plan for short-term and long-term adjustments to present residents with new content and skills.

2. Implement training in the new competencies:

• Prepare learners through a mix of didactic instruction and practical experiences.
• Develop and/or locate courseware and applied learning exercises.
• Stay informed about resources and best practices developed elsewhere that a program can draw upon.
• Adapt existing training activities to incorporate new competencies, e.g., addressing care management and cost-effectiveness during rounds, and discussing systems issues while reviewing individual patient cases.
• Implement new applications or learning exercises that have practical value for the resident, the program, and the training site, e.g., quality improvement projects.
• Make use of web-based instruction and other tools for self-paced learning.
• Take advantage of courseware, cases, applications, best practices, and strategies presented at conferences and posted online by interested organizations and other programs.

3. Implement ongoing assessment of learners and outcomes:

• Based on your objectives, define criteria for evaluating learners' knowledge, skills and attitudes across the competencies.
• Match the items to be assessed within each competency with appropriate instruments and respondents/reviewers. Add new questions to existing assessment instruments.
• Complete assessments routinely and provide feedback to the residents regularly.
• Make use of web-based instruments and other new information technologies for collecting and analyzing information.
• Take advantage of assessment instruments, best practices, and strategies presented at conferences and posted online by interested organizations and other programs.

The following model reflects the approach suggested above.



Outcomes Desired - Translate broad goals to specific knowledge and skills; organize the curriculum to present this content.

Content and Instruction - Prepare learners through a mix of didactic instruction and practical experiences; develop and/or locate courseware and applied learning exercises.

Assessment - Define criteria for evaluating learners' proficiencies and attitudes; use a variety of instruments throughout the duration of training.

Click here for recommended next steps for residency program directors.

Click here to read action steps cited by attendees at THCI's 2002 National Conference,"Are you ready? Practical Approaches for Achieving Required ACGME Competencies in Systems-based Practice and Practice-based Learning and Improvement".

Click here for references on teaching and assessing knowledge and skills contained within the competencies of Systems-based Practice and Practice-based Learning and Improvement.