Systems-based practice (SBP) is the sixth competency of the required ACGME core competencies in US-based residency programs. SBP aims to ensure that residents ( ) are aware of a larger context and system of health care and ( ) have the ability to effectively call upon system resources to provide care of optimal value ( ). Therefore diagnostic radiology residency training programs must provide SBP education.
The core competencies were introduced in 1999 and implemented between 2001 and 2002 as part of the outcome project by ACGME ( ). The outcome project is still ongoing, currently in its second phase that aims at “sharpening the focus and definition of the competencies and assessment tools” ( ). The SBP competency has received far less attention than the other five competencies, mostly because of its less defined nature when compared to the others ( ). Little has been published about this requirement in radiology, and its implications remain relatively unexplored ( ). In a relatively recent report only 3% of senior medical students identified system-based practice as the most relevant competency during residency and later in their careers ( ).
Upon completion of residency training, radiologists are expected ( ) to demonstrate a knowledge of, and apply appropriate criteria and other cost-effective health care principles to professional practice, ( ) to understand the role of regulatory agencies and licensing regulations, and ( ) to have knowledge of financing and reimbursement methods. Even though the range of topic content in SBP is broad, in other specialties and academic institutions SBP has become a synonym of patient safety and community involvement; while these two are crucial aspects of SBP, in radiology finance, turf wars, and other issues must be addressed in order to avoid forfeiting important benefits for the profession. Each of the SBP domains has potential benefits for the radiologist-in-training. Given the increased complexity in the interaction between radiology and other sub-specialties, what was previously described as “noninterpretative skills” related to SBP have been recognized as extremely important to achieve financial and overall professional success ( ). Among these noninterpretative skills are practical business issues, appropriateness criteria, medical organizational politics, practice management, and contracting. The importance of these skills has gained attention in forums from the RSNA Research and Education Foundation, American College of Radiology (ACR), and the Association of Program Directors in Radiology (APDR) ( ).
The purpose of this article is to review the significance of system-base practice in diagnostic radiology (SBR) training programs and to propose a comprehensive 2-year curriculum.
Rationale
An underpinning of SBP is that systems are designed to achieve the results they achieve, that outcomes depend more on the system than on the individuals, and thus, a system must be changed to achieve improvement ( ). In addition, wider knowledge of the system and its components makes it easier to improve because the next generation will be better aware of pitfalls in today’s system. Put in other terms, today’s residents must be prepared for tomorrow’s practice. In this regard, system-based represents a pillar knowledge for highly functional practicing radiologists ( ).
Change is better accepted when it comes from among those individuals directly affected by the outcomes (i.e., health care providers and patients). Therefore, radiology trainees share in the responsibility of generating and participating in the process of improving radiology services quality and safety.
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Implementation
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Key topics
Quality Improvement and Delivery System
Guarantying quality imaging services and measuring improvement
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Financial Environment: Costs
Cost-conscious medical imaging
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Medical Errors: Patient Safety
Patient advocacy
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Turf Battles
Radiologist role in patient care and as a health care leader
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Evaluation: Measuring achievement, assessing knowledge
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Utilization Rounds
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Strategic Planning: Technology Assessment
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Quality Improvement
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Limitations
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Conclusion
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Appendix 1
Curriculum
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References
1. Accreditation Council for Graduate Medical Education. The ACGME Outcome Project: An introduction. Available from www.acgme.org . Accessed January 2007.
2. Association of Directors of Anatomic and Surgical Pathology: Curriculum content and evaluation of resident competency in anatomic pathology: A proposal. Hum Pathol 2003; 34: pp. 1083-1090.
3. Oates E.: The six ACGME general competencies: Perceptions by applicants to a university-based radiology residency program, Scientific Paper..2006. April; Austin TX
4. Panek R., Deloney L., Park J., Goodwin W., Klein S., Ferris E.: Interdepartmental problem solving as a method for teaching and learning systems-based practice. Acad Radiol 2006; 13: pp. 1150-1154.
5. Neiman H.L.: Non-interpretative skills for radiology resident. AJR Am J Roentgenol 2000; 174: pp. 1523-1528.
6. Chan S.: Management education during radiology residency: Development of an educational practice. Acad Radiol 2004; 11: pp. 1308-1317.
7. Radiological Society of North America: RSNA Research and Education Foundation Consensus Conference: New Pathways for Educating Radiologists for the Future.2000. RSNA Conference Oak Brook, IL August 26-27
8. McLoud T.C.: Education in radiology: Challenges for the new millenium. AJR Am J Roentgenol 2000; 174: pp. 3-8.
9. Friedenberg R.M.: An endangered art: Teaching. Radiology 2000; 214: pp. 317-319.
10. Collins J., Hyde C., Gray L., et. al.: Radiology resident evaluation: A form that addresses the six competencies of the Accreditation Council for Graduate Medical Education. Acad Radiol 2002; 9: pp. 815-816.
11. Collins J., Herring W., Kwakwa F., et. al.: Current practices in evaluating radiology residents, faculty, and programs: Results of a survey of radiology residency program directors. Acad Radiol 2004; 11: 898–794
12. Berwick D.M.: A primer on leading the improvement of systems. BMJ 1996; 312: pp. 619-622.
13. Whitcomb M.E.: Future doctors should learn about our country’s healthcare system. Acad Med 2004; 79: pp. 105-106.
14. Collins J.: Education techniques for lifelong learning: Principles of adult learning. RadioGraphics 2004; 24: pp. 1483-1489.
15. Ziegelstein R.C., Fiebach N.H.: The mirror and the village: A new method for teaching practice-based learning and improvement and system-based practice. Acad Med 2004; 79: pp. 83-88.
16. Ganguli S., Pedrosa I., Yam C., Appignani B., Siewert B., Kressel H.: Part I: Preparing first-year radiology residents and assessing their readiness for on-call responsibilities. Acad Radiol 2006; 13: pp. 764-769.
17. Yam C., Kruskal J., Pedrosa I., Kressel H.: Part II: Preparing and assessing first-year radiology resident on-call readiness. Acad Radiol 2006; 13: pp. 770-773.
18. Ondategui-Parra S., Bhagwat J., Zou K., et. al.: Practice management performance indicators in academic radiology departments. Radiology 2004; 233: pp. 716-722.
19. Kaiser Family Foundation. Trends and indicators in the changing health care marketplace. Available from www.kff.org . Accessed January 2007.
20. Beever C., Karme M.: The cost of medical technologies. [monograph on the Internet]2003. Booz, Allen, Hamilton inc, Available from http://www.boozallen.com/media/file/137991.pdf
21. Beinfeld M., Gazelle G.: Diagnostic imaging costs: Are they driving up the costs of hospital care?. Radiology 2005; 235: pp. 934-939.
22. Maitino A., Levin D., Parker L., Rao V., Sunshine J.: Nationwide trends in rates of utilization of noninvasive diagnostic imaging among the Medicare population between 1993 and 1999. Radiology 2003; 227: pp. 113-117.
23. Committee on Quality of Health Care in America, Institute of Medicine: Kohn L.T.Corrigan J.M.Donaldson M.S.To Err Is Human: Building a Safer Health System.2000.National Academies PressWashington, DC:
24. Agency for Healthcare Research and Quality. Medical errors: The scope of the problem. Fact sheet, publication n AHRQ 00-P037. Rockville, MD; Agency for Healthcare Research and Quality. Available from www.ahrq.gov/qual/errback.htm .
25. Miniño A., Heron M., Smith B.: Deaths: Preliminary data for 2004. National vital statistics reports; l54 (19)2006.National Center for Health StatisticsHyattsville, MD
26. Shu K., MacKenzie J., Smith J., et. al.: Lowering the thyroid dose in screening examinations of the cervical spine. Emerg Radiol 2006; 12: pp. 133-136.
27. Wall B., Kendall G., Edwards A., Bouffler S., Muirhead C., Meara J.: What are the risk from medical x-rays and other low dose radiation?. Br J Radiol 2006; 79: pp. 285-294.
28. Mettler F.A., Wiest P.W., Locken J.A., Kelsey C.A.: CT scanning: Patterns of use and dose. J Radiol Protect 2001; pp. 353-359.
29. Shrimpton PC, Edyvean S. CT scanner dosimetry. Br J Radiol 71; 8410:1–3.
30. Bader B.: Quality and patient safety: Engaging your board to take the lead. Healthc Exec 2006; 21: pp. 64-67.
31. Mather R.: Patient focused imaging: Low dose vision. Clin Adv Volum CT 2005; 1: pp. 4-8.
32. Committee on Drugs and Contrast Media of the American College of Radiology. Manual on Contrast Media. American College of Radiology 2004. Available from http://www.acr.org/s_acr/bin.asp?CID=2131&DID=24981&DOC=FILE.PDF .
33. Pedersen M.: Safety update on the possible causal relationship between gadolinium-containing MRI agents and nephrogenic systemic fibrosis. J Magn Reson Imaging 2007; 25: pp. 881-883.
34. Partain C.L.: On the potential causal relationship between gadolinium-containing MRI agents and nephrogenic systemic fibrosis. J Magn Reson Imaging 2007; 25: pp. 879-880.
35. Bongartz G.: Imaging in the time of NFD/NSF: Do we have to change our routines concerning renal insufficiency?. MAGMA 2007; 20: pp. 57-62.
36. Manieiro M.: Teaching Patient Safety, Scientific Paper.Proceedings of the AUR 54th annual meeting.2006. April; Austin, TX
37. Moores M., Anwyl D., Connolly P., et. al.: IT-driven patient safety at the heart of radiology service improvement. Med Inform Internet Med 2005; 30: pp. 123-133.
38. Joint Committee on Accreditation of Health Care Organizations. JCAHO 2007 National Patient Safety Goals. Available from www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals .
39. Levin D., Rao V.: Turf wars in radiology: Introduction. J Am Coll Radiol 2004; 1: pp. 23-25.
40. Collins J.: Radiology training: A program director’s perspective. AJR Am J Roentgenol 2001; 177: pp. 1009-1010.
41. Smith R.: What doctors and managers can learn from each other. BJM 2003; 326: pp. 610-611.
42. Lee S.I.: Radiology utilization rounds of the Massachusetts General Hospital: A win-win situation. J Am Coll Radiol 2006; 3: pp. 558-559.