Exploring clinician perspectives of systems-based practice: A physician training challenge

IF 1.4 Q4 MEDICINE, RESEARCH & EXPERIMENTAL

Clinical Teacher Pub Date : 2024-11-06 DOI:10.1111/tct.13840

Ami L. DeWaters, Somalee Banerjee, James Bruce, Rob Cooney, Halle B. Ellison, Paul Haidet, Lindsay Mazotti, James B. Reilly, Jed D. Gonzalo

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引用次数: 0

Abstract

Introduction

Systems-based practice (SBP) has been a competency in US graduate medical education for over 20 years, but it is not well implemented. SBP is loosely defined as physician's responsiveness to the larger system of healthcare. The aim of this study was to describe healthcare professionals' perspectives regarding: (1) their knowledge and beliefs about SBP and (2) their beliefs regarding factors in clinical learning environments (CLE) that facilitate or hinder operationalisation and learning of SBP.

Methods

Semi-structured interviews were conducted between November 2020 and April 2021 with 42 individuals from four health systems. Participants were healthcare professionals involved in graduate medical education, including physicians and interprofessional clinicians (e.g., nursing staff). Interviews were transcribed and coded using a social constructivist, codebook thematic analysis approach and themes were agreed upon through discussion amongst the research team.

Results

Five themes were constructed: (1) SBP remains a challenge to define, (2) SBP may be intuitively understood, particularly when framed at the microsystem level, (3) SBP aligns with the Health Systems Science framework, (4) SBP learning must be intentionally integrated into the CLE, through training such as onboarding and (5) multidisciplinary settings and work processes are critical to engage in SBP. Workload compression is a barrier to SBP implementation.

Conclusions

Healthcare professionals highlighted that current CLEs are not designed to prioritise SBP. Graduate medical education programmes may benefit from focusing systems content at the microsystem level and purposefully integrating onboarding procedures, clinical settings and rotations specifically designed to teach SBP into their residencies.

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查看原文本刊更多论文

探索临床医生对基于系统的实践的看法：医生培训的挑战。

导言：基于系统的实践（Systems-based Practice，SBP）成为美国医学研究生教育的一项能力已有 20 多年，但其实施情况并不理想。SBP 的宽泛定义是医生对更大的医疗保健系统的反应能力。本研究旨在描述医护人员对以下方面的看法：（1）他们对 SBP 的认识和信念；（2）他们对临床学习环境（CLE）中促进或阻碍 SBP 操作和学习的因素的看法：在 2020 年 11 月至 2021 年 4 月期间，对来自四个医疗系统的 42 人进行了半结构式访谈。参与者为参与医学研究生教育的医护人员，包括医生和跨专业临床医生（如护理人员）。采用社会建构主义的编码本主题分析方法对访谈内容进行了转录和编码，并通过研究团队之间的讨论就主题达成了一致意见：构建了五个主题：(1) SBP 的定义仍然是一个挑战；(2) SBP 可以被直观地理解，尤其是在微观系统层面；(3) SBP 符合卫生系统科学框架；(4) SBP 的学习必须通过入职培训等培训有意识地融入 CLE；(5) 多学科设置和工作流程对于参与 SBP 至关重要。工作量压缩是实施 SBP 的障碍：医护人员强调，目前的继续医学教育课程在设计上并没有优先考虑 SBP。医学研究生教育计划可将系统内容集中在微观系统层面，并有目的地将专门为教授 SBP 而设计的入职程序、临床环境和轮转纳入住院医师培训中，从而从中受益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Teacher MEDICINE, RESEARCH & EXPERIMENTAL-

CiteScore

2.90

自引率

5.60%

发文量

113

期刊介绍： The Clinical Teacher has been designed with the active, practising clinician in mind. It aims to provide a digest of current research, practice and thinking in medical education presented in a readable, stimulating and practical style. The journal includes sections for reviews of the literature relating to clinical teaching bringing authoritative views on the latest thinking about modern teaching. There are also sections on specific teaching approaches, a digest of the latest research published in Medical Education and other teaching journals, reports of initiatives and advances in thinking and practical teaching from around the world, and expert community and discussion on challenging and controversial issues in today"s clinical education.