Defining Successful Practice Within Health Systems Science Among Entering Residents: A Single-Institution Qualitative Study of Graduate Medical Education Faculty Observations.

PURPOSE: The American Medical Association's Accelerating Change in Medical Education consortium defined health systems science (HSS) as the study of how health care is delivered, how health care professionals work together to deliver that care, and how the health system can improve patient care and health care delivery. This framework is increasingly being incorporated into medical school curricula. Graduate medical education (GME) had previously elevated systems-based practice (SBP) as a core competency, but expectations are defined by specialty-specific milestones. The lack of a shared competency framework between undergraduate medical education (UME) and GME makes it challenging to ensure that entering residents are prepared to implement HSS/SBP concepts in the workplace. The authors explored GME faculty observations of residents exemplifying successful practice across HSS domains to inform targets for UME training and assessment. METHOD: Authors performed a single-institution qualitative study using transcribed phone interviews with eligible Vanderbilt residency program directors, associate program directors, and core faculty. Participants described observations of successful residents within each HSS domain. Two researchers independently coded, discussed, and reconciled deidentified transcripts using inductive-deductive approaches to identify themes. RESULTS: Seventeen faculty participated across specialties (17/39, 45%). Faculty responses emphasize precurricular experiences including professional degrees, work experience, extracurriculars, and medical school exposure. Importantly, successful residents exhibit foundational core workforce characteristics including growth mindset, curiosity, and a desire to learn about systems. GME faculty identified HSS domain-specific skills, noting distinctions among learning environments. Outcomes resulting from residents' application of HSS concepts include delivering high-quality, person-centered care and systems improvements. CONCLUSIONS: Descriptions of successful practice within HSS domains highlight preparatory experiences and core workforce characteristics and outline entry-level HSS behaviors. Conceptualized in a logic model framework, these findings describe key inputs, learning activities, outputs, and outcomes for systems-prepared entering residents bridging the UME-GME transition.

Discharging Mrs. Fox: A Team-Based Interprofessional Collaborative Standardized Patient Encounter.

INTRODUCTION: In 2003, the Institute of Medicine recommended that interprofessional education be incorporated into the training programs of health care professionals. However, many logistical challenges hinder formal interprofessional learning in health care profession programs. METHODS: This resource is a 3-hour interprofessional small-group session designed for health professions student teams to engage in a standardized patient encounter, each team member contributing a profession-specific perspective to create a collaborative care plan across five discharge decisions. The activity includes a simulated standardized patient encounter and debrief session wherein students discuss the role of bias and communication and create a collaborative care plan. RESULTS: Following the activity, participants were surveyed about the value of the educational experience. Over 12 months, 106 students (81 medicine, nine nursing, 16 pharmacy) participated in the interprofessional activity. Eighty-four students responded to the postevent survey (79% response rate). Students were confident that the experience helped them integrate profession-specific knowledge, create a shared care plan, and understand how interprofessional collaboration contributes to quality care. The debriefing session and interprofessional interaction were an integral component of the experience. DISCUSSION: This resource is a feasible interprofessional small-group activity that has been implemented without excessive faculty time or institutional resources. It is adaptable to institutional needs, local resources, level of trainee, and professions. The session provides interprofessional students the opportunity to engage with one another and with the patient in a collaborative decision-making activity focused around a critical transition of care.