Rationale and Objectives
Radiology residents must now participate in a learning activity that involves identification and analysis of system errors and implementation of potential solutions. Evidence of participation must be documented in the resident’s learning portfolio.
Materials and Methods
An activity based on adult learning principles was designed for residents to increase their knowledge of health care systems and problems; gain experience in writing a proposal, conducting an investigation, and reporting results; organize and present information in a supportive environment; and document participation in their portfolio. Postgraduate year 2 residents identify a systems problem. A written proposal is required and must include a “plan” that includes a hypothesis, a methods section that explains what they will “do” as an intervention, a “study” that involves collection and analysis of relevant data, and a systems change or “act.” Proposals approved by the program director are presented to the radiology department. Residents complete projects, evaluate their effectiveness, and present their results by spring of postgraduate year 3.
Results
Goals, objectives, and guidelines were written. Assessment tools were identified. From 2006 to 2008, nine projects were proposed and conducted by 12 residents. Local and national systems issues were selected, and interventions involved residents, faculty, and medical students. A timeline was imposed to promote sustained effort.
Conclusion
Opportunities of daily work can be used to teach and learn systems-based practice concepts. Residents can use the scientific method to test effects of change on health care systems. Relevant and practical projects enable residents to learn while improving their clinical and learning environments.
Systems-based practice (SBP) is one of six general competencies that all Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs must integrate into their curriculum. Competence in SBP is demonstrated by awareness of and responsiveness to the overall health care system, as well as the ability to effectively use system resources to provide optimal patient care ( ). At a minimum, residents are expected to work effectively within health systems relevant to their clinical specialty, consider cost and risk-benefit analysis in the delivery of patient care, advocate for quality patient care and optimal care systems, work in interprofessional teams to maximize patient safety, and participate in identifying system errors and implementing solutions.
Additional radiology specific program requirements for SBP took effect July 1, 2008. As consultants for other health care professionals, radiologists must be able to provide information regarding the most appropriate use of imaging resources. This requires learning how departmental, institutional, local, and national healthcare systems function interdependently and how system improvements involve group and individual efforts. Radiologists must also be able to tackle systems problems that compromise their ability to provide efficient and effective patient care. This requires learning to identify and analyze systems problems, develop and implement solutions, and evaluate the effectiveness of a systems change. SBP competence will be documented in the resident’s learning portfolio and will include evidence of the resident’s participation in identifying system errors and implementing potential solutions ( ).
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Materials and methods
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Table 1
Use of Adult Learning Principles in SBP Project Design
Adult Learning Principle SBP Project Design Residents are autonomous and self-directing. Give residents freedom to choose and design their own projects. Support residents by providing advice and encouragement. Residents have a reservoir of experience that is a rich resource for learning. Allow residents to draw on their prior knowledge and life experience to create solutions to systems problems. Encourage individual opinions and allow them to be freely expressed in a respectful environment. Residents learn when they have a need to know how to perform a task or solve a problem. Create readiness to learn by allowing residents to select a project that is practical and relevant to their clinical work or other responsibilities. Residents are goal-oriented and training is a competence development process. Provide well defined instructions with clear educational goals and objectives (why, what, and how). Connect activity to resident’s achievement of competence.
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Results
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Table 2
Summary of Inaugural SBP Projects
Project Participants Related Competencies System Type Development of a desktop communication tool for better and faster communication within the University Medical System Team PGY-3 and PGY3 Interpersonal and communication skills/patient care: reporting Local Teaching dictation skills to new radiology residents and providing sample normal reports Individual PGY-3 Interpersonal and communication skills/patient care: reporting Local Creation of a radiology phonebook to improve efficiency and provide better clinical service on call Team PGY-2 and PGY-3 Interpersonal and communication skills/patient care: reporting Local Integration of the ACR Appropriateness Criteria® into the medical student curriculum Individual PGY-2 Patient care: use of imaging resources National Impact of Voice Recognition on Report Turnaround Time at UAMS: can we improve report turn-around time and increase cost savings? Individual PGY-2 Interpersonal and communication skills/patient care: reporting Local Resident driven-case conferences: improving medical student and peer teaching skills Individual PGY-3 Interpersonal and communication skills/patient care/practice-based learning and improvement Local Who and how to lobby: governmental impact and relations with radiology medical systems Individual PGY-2 Professionalism: political action National Creation of radiology interest group to spark awareness of our specialty among undergraduate medical students Team PGY-2 and PGY-3 Interpersonal and communication skill/ professionalism: recruitment Local Identification of program-specific factors of interest to the radiology residency candidate Individual PGY-3 Professionalism: recruitment Local
ACR, American College of Radiology; PGY, postgraduate year; UAMS, University of Arkansas Medical Sciences.
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Discussion
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