Systems-Based Practice - ACGME Competencies

ACGME Common Program Requirements state that each residency/fellowship program must require its residents/fellows to obtain competence Systems Based Practice. It is necessary for programs to define the specific knowledge, skills, behaviors, and attitudes required, as well as provide educational experiences as needed in order for their residents and fellows to demonstrate competency in the area of Systems Based Practice.

Systems-Based Practice requires residents/fellows to demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents/fellows are expected to:

• Work effectively in various health care delivery settings and systems relevant to their clinical specialty
• Coordinate patient care within the health care system relevant to their clinical specialty;
• Incorporate considerations of cost awareness and risk benefit analysis in patient care;
• Advocate for quality patient care and optimal patient care systems;
• Work in inter-professional teams to enhance patient safety and improve patient care quality; and
• Participate in identifying system errors and in implementing potential systems solutions.

Program Improvement activities assure full integration of this and other competencies with learning and clinical care. Review several recommended evaluation methodologies.

Core Assessment Systems are essential to improving resident performance in this competency as well as the other competencies. Review an example of comprehensive core assessment system, which uses multiple methodologies and raters.

Key Components:

• Knowledge of the larger context and system of health care
• Use of resources within the system to provide excellent patient care
• Knowledge of patient safety and advocacy

Examples of Systems-Based Practice in Curricula:

• Goals and Objectives - Example 1
• Goals and Objectives - Example 2
• Goals and Objectives - Example 3

Examples of Systems-Based Practice Evaluation Tools:

• Evaluation of Competencies (generic competencies)
• Annual Evaluation Form with Competencies (use for promotion)
• Summary Evaluation Form with Competencies (use for graduation)