A self-instructional model to teach systems-based practice and practice-based learning and improvement.

BACKGROUND: When mandated as resident competencies in 1999, systems-based practice (SBP) and practice-based learning and improvement (PBLI) were new concepts to many. OBJECTIVE: To describe and evaluate a 4-week clinical elective (Achieving Competence Today-ACT) to teach residents SBP and PBLI. DESIGN: ACT consisted of a four-week active learning course and follow-up teaching experience, guided and supported by web-based materials. The curriculum included readings, scheduled activities, work products including an improvement project, and weekly meetings with a non-expert preceptor. The evaluation used a before-after cross-comparison of ACT residents and their peers. PARTICIPANTS: Seventy-eight residents and 42 faculty in 18 US Internal Medicine residency programs participated between 2003 and 2005. RESULTS AND MAIN MEASUREMENTS: All residents and faculty preceptors responded to a knowledge test, survey of attitudes, and self-assessment of competency to do 15 tasks related to SBP/PBLI. All measures were normalized to a 100-point scale. Each program's principal investigator (PI) identified aspects of ACT that were most and least effective in enhancing resident learning. ACT residents' gains in knowledge (4.4 on a 100-point scale) and self-assessed competency (11.3) were greater than controls' (-1.9, -8.0), but changes in attitudes were not significantly different. Faculty preceptors' knowledge scores did not change, but their attitudes became more positive (15.8). PIs found a ready-to-use curriculum effective (rated 8.5 on a 10-point scale). CONCLUSIONS: ACT increased residents' knowledge and self-assessment of their own competency and raised faculty's assessment of the importance of residents' learning SBP/PBLI. Faculty content expertise is not required for residents to learn SBP/PBLI.

Educating interprofessional learners for quality, safety and systems improvement.

Most health professionals in training, as well as those in practice, lack the knowledge and skills they need to play an effective role in systems improvement. Until very recently, these competencies were not included in formal (or informal) educational curricula. Interprofessional collaboration - another core competency needed for successful systems improvement - is also inadequately taught and learned. Achieving Competence Today (ACT) was designed as a new model for interprofessional education for quality, safety and health systems improvement. The core of ACT is a four-module active learning course during which learners from different disciplines work together to develop a Quality Improvement Project to address a quality or safety problem in their own practice system. In this paper we describe the ACT program and curriculum model, discuss our strategies for maximizing ACT's interprofessional potential, and make recommendations for the future.