Systems-based Practice Competency Research Articles

Systems-Based Practice Assessed With a Performance-Based Examination Simulated and Scored by Standardized Participants in the Health Care System: Feasibility and Psychometric Properties

Background: Systems-based practice is one of the six general competencies proposed by the Accreditation Council for Graduate Medical Education in their Outcome Project. However, little has been published on its assessment—possibly because the systems-based practice competency has been viewed as difficult to define and measure. Purpose: The purpose of this study was to determine whether a full performance-based examination of systems-based practice cases simulated and scored by standardized participants in the health care system could feasibly be constructed and implemented that would provide reliable and valid measurements. Methods: In the 1st year of the project (2008), four systems-based practice cases were developed and pilot tested with 13 residents. Videotapes of residents were studied to develop an instrument for subsequent assessment of performance by standardized participants. In the 2nd year (2009), the examination was expanded to a full 12 cases, which were completed by 11 second-year residents, and psychometric analyses were performed on the scores. Results: The generalizability coefficient for the full 12-case examination based on scoring by standardized participants was .71, which is nearly equal to that based on scoring by faculty physician observers, which was .78. The correlation between total scores obtained with standardized participants and physician observers was .78. Conclusions: A performance-based examination can provide a feasible and reliable assessment of systems-based practice. However, attempts to evaluate convergent validity and discriminant validity—by correlating systems-based practice performance assessments with mean global ratings of residents on the 6 competencies by faculty throughout training—were unsuccessful, due to a lack of independence between the rated dimensions.

A Dedicated General Competencies Curriculum for Radiology Residents: Development and Implementation

The Accreditation Council on Graduate Medical Education (ACGME) through its Outcome Project requires training programs in all medical specialties to integrate six general competencies into residency training: patient care, medical knowledge, professionalism, interpersonal and communication skills, practice-based learning and improvement, and systems-based practice. In response, a required, or dedicated general competencies rotation for diagnostic radiology residents was instituted. We describe the development and implementation of this rotation. The rotation augments the core curriculum, with primary emphasis placed on resident-initiated quality improvement (QI) and quality assurance (QA) projects. Between academic years 2003 and 2009 diagnostic radiology residents completed 38 QI/QA projects and performed clinical float coverage for the department. Residents met requirements of the systems-based practice and practice-based learning competency domains. In this process, residents improved their medical knowledge, interpersonal communication skills, professionalism, and provided patient care. A dedicated general competencies rotation can be successfully implemented, and complement the requirements of the core curriculum. In combination with coverage for clinical services, the rotation makes a substantive contribution to resident education to further the goal of improved patient care.

Curriculum Providing Cognitive Knowledge and Problem-Solving Skills for Anesthesia Systems-Based Practice

Residency programs accredited by the ACGME are required to teach core competencies, including systems-based practice (SBP). Projects are important for satisfying this competency, but the level of knowledge and problem-solving skills required presupposes a basic understanding of the field. The responsibilities of anesthesiologists include the coordination of patient flow in the surgical suite. Familiarity with this topic is crucial for many improvement projects. A course in operations research for surgical services was originally developed for hospital administration students. It satisfies 2 of the Institute of Medicine's core competencies for health professionals: evidence-based practice and work in interdisciplinary teams. The course lasts 3.5days (eg, 2 weekends) and consists of 45 cognitive objectives taught using 7 published articles, 10 lectures, and 156 computer-assisted problem-solving exercises based on 17 case studies. We tested the hypothesis that the cognitive objectives of the curriculum provide the knowledge and problem-solving skills necessary to perform projects that satisfy the SBP competency. Standardized terminology was used to define each component of the SBP competency for the minimum level of knowledge needed. The 8 components of the competency were examined independently. Most cognitive objectives contributed to at least 4 of the 8 core components of the SBP competency. Each component of SBP is addressed at the minimum requirement level of exemplify by at least 6 objectives. There is at least 1 cognitive objective at the level of summarize for each SBP component. A curriculum in operating room management can provide the knowledge and problem-solving skills anesthesiologists need for participation in projects that satisfy the SBP competency.

Perspective: Transformative Learning: A Framework Using Critical Reflection to Link the Improvement Competencies in Graduate Medical Education

Quality improvement (QI) in health care involves activities ranging from enhancing personal practice to reforming the larger health care system. The Accreditation Council for Graduate Medical Education recognizes this broad definition of QI in its requirement that physicians-in-training demonstrate competence in practice-based learning and improvement (PBLI) and systems-based practice (SBP). Creative metaphors have been used to teach the PBLI and SBP competencies, but conceptual frameworks describing the relationship between these competencies are needed. Transformative learning is an adult education theory that states individuals must critically reflect on life events in order to change their beliefs or behaviors. The authors propose that critical reflection during transformative learning can conceptually link PBLI and SBP. Reflection on personal experience with suboptimal patient care leads to recognizing personal or system limitations. Addressing personal limitations improves individual practice (PBLI), whereas applying QI methodologies leads to large-scale improvements (SBP). Educators who adopt the transformative learning framework should be able to design meaningful QI curricula that encourage residents to be reflective and empower them with QI skills.

Evaluating Professionalism, Practice-Based Learning and Improvement, and Systems-Based Practice: Utilization of a Compliance Form and Correlation with Conflict Styles

The purpose of this article was to develop and determine the utility of a compliance form in evaluating and teaching the Accreditation Council for Graduate Medical Education competencies of professionalism, practice-based learning and improvement, and systems-based practice. In 2006, we introduced a 17-item compliance form in an obstetrics and gynecology residency program. The form prospectively monitored residents on attendance at required activities (5 items), accountability of required obligations (9 items), and completion of assigned projects (3 items). Scores were compared to faculty evaluations of residents, resident status as a contributor or a concerning resident, and to the residents' conflict styles, using the Thomas-Kilmann Conflict MODE Instrument. Our analysis of 18 residents for academic year 2007-2008 showed a mean (standard error of mean) of 577 (65.3) for postgraduate year (PGY)-1, 692 (42.4) for PGY-2, 535 (23.3) for PGY-3, and 651.6 (37.4) for PGY-4. Non-Hispanic white residents had significantly higher scores on compliance, faculty evaluations on interpersonal and communication skills, and competence in systems-based practice. Contributing residents had significantly higher scores on compliance compared with concerning residents. Senior residents had significantly higher accountability scores compared with junior residents, and junior residents had increased project completion scores. Attendance scores increased and accountability scores decreased significantly between the first and second 6months of the academic year. There were positive correlations between compliance scores with competing and collaborating conflict styles, and significant negative correlations between compliance with avoiding and accommodating conflict styles. Maintaining a compliance form allows residents and residency programs to focus on issues that affect performance and facilitate assessment of the ACGME competencies. Postgraduate year, behavior, and conflict styles appear to be associated with compliance. A lack of association with faculty evaluations suggests measurement of different perceptions of residents' behavior.

A Systems Approach to Morbidity and Mortality Conference

A Systems Approach to Morbidity and Mortality Conference Jason H. Szostek, MD, Mark L. Wieland, MD, MPH, Laura L. Loertscher, MD, MPH, Darlene R. Nelson, MD, Christopher M. Wittich, MD, PharmD, Furman S. McDonald, MD, MPH, Joseph C. Kolars, MD, Darcy A. Reed, MD, MPH From the Department of Medicine, Mayo Clinic, Rochester, Minn; Department of Medicine, Providence St Vincent Medical Center, Portland, Ore; Internal Medicine Residency Program, Mayo Clinic, Rochester, Minn; Department of Medicine, University of Michigan, Ann Arbor, Mich.

Teaching systems-based competency in anesthesiology residency: development of an education and assessment tool.

The Accreditation Council for Graduate Medical Education requires programs to educate and evaluate residents in 6 competencies, including systems-based practice. We designed a survey and assessment tool to address the competency as it pertains to anesthetic drug costs in an academic center. Residents, certified registered nurse anesthetists, and faculty were asked to complete an anesthetic drug-cost survey without relying on reference materials. After a combination of compulsory in-class didactic sessions and web-based education, the participants were asked to design an anesthetic, give example cases, and determine costs. The initial task was repeated 1year later. Our preintervention survey revealed that most practitioners knew very little about anesthetic drug costs, regardless of level of training or degree. All residents completed the mandatory online education tool, more than 80% attended the departmental grand rounds program, and 100% met the goal of designing an anesthetic for all cases within the preset price limit. A repeat of the cost estimate produced an improvement in cost estimates with reduction in variability (P < .05, Student unpaired t test), although estimates of volatile anesthetic and reversal agent costs did not achieve significance at the .05 level for any of the 3 cases. Introducing a formalized teaching and assessment tool has improved our residents' understanding of anesthetic drug costs, and improved our ability to teach and assess the systems-based practice competency.

A pilot study using Cultural Consensus Analysis to measure Systems-Based Practice performance

Objectives: This pilot study was designed to compare the performance of ‘relationship-based’ statements from a cultural consensus analysis, a standard anthropological technique for measuring value differences, with ‘gold standard’ patient and nursing satisfaction surveys often used in 360° evaluation of the systems-based practice competency. Methods: We performed a cross-sectional correlation study in a teaching clinic in the United States. A single research assistant approached a convenience sample of ten residents, ten clinic staff, and ten patients per resident (120 participants). The cumulative scores for each resident on patient and nursing satisfaction surveys were compared to the average difference in cultural consensus analysis ranking between patient or nurse and the resident for two statements using Spearman rank correlation coefficients. These statements were selected because they represent the ‘relationship-based care’ pole in a previously validated conceptual model of clinic. Results: The correlation between patient satisfaction cumulative scores and the difference in patient and resident cultural consensus analysis rankings on ‘goals’ was -0.527 (less difference between residents’ and patients’ value ranking correlates with higher satisfaction). The correlation with ‘changes’ was -0.351. The correlation between nursing satisfaction cumulative scores and the difference in nursing staff and resident cultural consensus analysis rankings on ‘goals’ was -0.086. The correlation with ‘changes’ was -0.415. Conclusions: Systems-based practice is a notoriously difficult competency to evaluate. These moderate correlations in the expected direction between commonly used 360° evaluation instruments and this cultural consensus analysis tool suggest that it can provide an alternative measure of this competency.

Is There a Relationship Between High-Quality Performance in Major Teaching Hospitals and Residents’ Knowledge of Quality and Patient Safety?

The relationship of the quality of teaching hospitals' clinical performance to resident education in quality and patient safety is unclear. The authors studied residents' knowledge of these areas in major teaching hospitals with higher- and lower-quality performance rankings. They assessed the presence of formal and informal quality curricula to determine whether programmatic differences exist. The authors used qualitative research methodology with purposeful sampling. They gathered data from individual structured interviews with residents and key educational and quality leaders in six medical schools and teaching hospitals, which represented a range of quality performance rankings, geographic regions, and public or private status. No relationship emerged between a hospital's quality status, residents' curriculum, and the residents' understanding of quality. Residents' definitions of quality and safety and their knowledge of the practice-based learning and systems-based practice competencies were indistinguishable between hospitals. Residents in all programs had extensive patient safety knowledge acquired through an informal curriculum in the hospital setting. A formal curriculum existed in only two programs, both of them ambulatory settings. Residents' learning about quality and patient safety is extensive, largely through a positive informal curriculum in the teaching hospital and, less frequently, via a formal curriculum. No relationship was found between the quality performance of the teaching hospital and the residents' curriculum or understanding of quality or safety. Residents seem to learn through an informal curriculum provided by hospital initiatives and resources, and thus these data suggest the importance of major teaching hospitals in quality education.

Systems-Based Practice Defined: Taxonomy Development and Role Identification for Competency Assessment of Residents

To demonstrate a methodology for coding and taxonomy development and to operationally define residents' competence in systems-based practice (SBP) in terms of observable roles, actions, and behaviors. The Accreditation Council for Graduate Medical Education's (ACGME's) full-text definition of SBP and the 6 discrete expectations it contains were content analyzed. Structured interviews of 88 health care professionals using a variant of focus group interviews called nominal group processes were conducted and qualitatively analyzed to identify the key attributes of SBP. Themes obtained from these 2 procedures were conceptually matched and organized to create a taxonomy of observable SPB behaviors and the SBP domain. Six general resident roles emerged, under which 35 specific behavioral attributes were subsumed. From the SBP domain specified. Sample SBP items categorized by roles were derived that reflected "in-context" representations of ACGME SBP expectations. Our comprehensive analysis created an operational representation of the SBP competency. The taxonomy development model provides a framework for constructing assessment instrument(s) that could be applied to the other ACGME competencies or complex concepts in medical education.

Development of the Objective Structured System-Interaction Examination

The purpose of this study was to develop an objective method of evaluating resident competency in systems-based practice. Faculty developed a 12-station examination, the Objective Structured System-Interaction Examination (OSSIE), patterned after the Objective Structured Clinical Examinations (OSCEs), to evaluate residents' ability to effectively work within the complex medical system of care. Scenarios consisted of multiple situations, such as patient hand-offs, consultations, complicated discharges, and family meetings, in which residents interacted with simulated professionals, simulated patients, and simulated family members to demonstrate the systems-based skills. Twelve second-year residents participated in the OSSIE. Along with the standardized professionals, a faculty member provided the resident with immediate feedback and completed an evaluation form designed specifically to assess systems-based practice. Residents, faculty, and staff evaluated the OSSIE and felt it provided a rich learning experience and was a beneficial means of formative assessment. The residents' third-year learning experiences were adapted to meet their needs, and suggestions were offered for curriculum revision. The OSSIE is unique in that it uses standardized professionals, involves scenarios in a variety of settings, and incorporates current technology, including an electronic health record and a state-of-the-art simulation laboratory, into the examination. Challenges to implementation include faculty time, scheduling of residents, and availability of resources. By using the OSSIE, faculty are able to assess, provide constructive feedback, and tailor training opportunities to improve resident competence in systems-based practice. Reliability and validity of an instrument developed for use with the OSSIE are currently being determined.

A Systems Approach for Implementing Practice-Based Learning and Improvement and Systems-Based Practice in Graduate Medical Education

The Accreditation Council for Graduate Medical Education (ACGME) initiated its Outcome Project to better prepare physicians-in-training to practice in the rapidly changing medical environment and mandated assessment of competency in six outcomes, including Practice-Based Learning and Improvement (PBLI) and Systems-Based Practice (SBP). Before the initiation of the Outcome Project, these competencies were not an explicit element of most graduate medical education training programs. Since 1999, directors of ACGME-accredited programs nationwide have been challenged to teach and assess these competencies. The authors describe an institution-wide curriculum intended to facilitate the teaching and assessment of PBLI and SBP competencies in the 115 ACGME-accredited residency and fellowship programs (serving 1,327 trainees) sponsored by Mayo School of Graduate Medical Education. Strategies to establish the curriculum in 2005 included development of a Quality Improvement (QI) curriculum Web site, one-on-one consultations with program directors, a three-hour program director workshop, and didactic sessions for residents and fellows on core topics. An interim program director self-assessment survey revealed a 13% increase in perceived ability to measure competency in SBP, no change in their perceived ability to measure competence in PBLI, a 15% increase in their ability to provide written documentation of competence in PBLI, and a 35% increase in their ability to provide written documentation of competence in SBP between 2005 and 2007. Nearly 70% of the programs had trainees participating in QI projects. Further research is needed to evaluate the cost-effectiveness of such a program and to measure its impact on learner knowledge, skills, and attitudes and, ultimately, on patient outcomes.

Preparing Psychiatric Residents for the "Real World": A Practice Management Curriculum

The authors describe a course designed for residents to develop the knowledge and skills necessary to collaborate and successfully compete in today's complex health care environment and to achieve competency in systems-based practice. Postgraduation surveys demonstrated a need for improvement in preparing residents for practice management issues. The authors outline a 32-week practice management curriculum for postgraduate-year 3 (PGY 3) psychiatric residents. The course was rated highly by residents in terms of topics covered, faculty involvement, and overall expectations. The project assignments completed by the residents were effective in creating objective change in the resident outpatient practice. Practice management is an essential part of residency training and can be successfully integrated into the residents' clinical practice experience. Future steps include assessment of the graduates at 1 and 5 years postgraduation to evaluate the long-term efficacy of the course.

Practice management education during surgical residency

Background Surgical education has undergone radical changes in the past decade. The introductions of laparoscopic surgery and endovascular techniques have required program directors to alter surgical training. The 6 competencies are now in place. One issue that still needs to be addressed is the business aspect of surgical practice. Often residents complete their training with minimal or no knowledge on coding of charges or basic aspects on how to set up a practice. We present our program, which has been in place over the past 2 years and is designed to teach the residents practice management. Methods The program begins with a series of 10 lectures given monthly beginning in August. Topics include an introduction to types of practices available, negotiating a contract, managed care, and marketing the practice. Both medical and surgical residents attend these conferences. In addition, the surgical residents meet monthly with the business office to discuss billing and coding issues. These are didactic sessions combined with in-house chart reviews of surgical coding. The third phase of the practice management plan has the coding team along with the program director attend the outpatient clinic to review in real time the evaluation and management coding of clinic visits. Results Resident evaluations were completed for each of the practice management lectures. The responses were recorded on a Likert scale. The scores ranged from 4.1 to 4.8 (average, 4.3). Highest scores were given to lectures concerning negotiating employee agreements, recruiting contracts, malpractice insurance, and risk management. The medical education department has tracked resident coding compliance over the past 2 years. Surgical coding compliance increased from 36% to 88% over a 12-month period. The program director who participated in the educational process increased his accuracy from 50% to 90% over the same time period. Conclusions When residents finish their surgical training they need to be ready to enter the world of business. These needs will be present whether pursuing a career in academic medicine or the private sector. A program that focuses on the business aspect of surgery enables the residents to better navigate the future while helping to fulfill the systems-based practice competency.

Validity Evidence for an OSCE to Assess Competency in Systems-Based Practice and Practice-Based Learning and Improvement: A Preliminary Investigation

To determine the psychometric properties and validity of an OSCE to assess the competencies of Practice-Based Learning and Improvement (PBLI) and Systems-Based Practice (SBP) in graduate medical education. An eight-station OSCE was piloted at the end of a three-week Quality Improvement elective for nine preventive medicine and endocrinology fellows at Mayo Clinic. The stations assessed performance in quality measurement, root cause analysis, evidence-based medicine, insurance systems, team collaboration, prescription errors, Nolan's model, and negotiation. Fellows' performance in each of the stations was assessed by three faculty experts using checklists and a five-point global competency scale. A modified Angoff procedure was used to set standards. Evidence for the OSCE's validity, feasibility, and acceptability was gathered. Evidence for content and response process validity was judged as excellent by institutional content experts. Interrater reliability of scores ranged from 0.85 to 1 for most stations. Interstation correlation coefficients ranged from -0.62 to 0.99, reflecting case specificity. Implementation cost was approximately $255 per fellow. All faculty members agreed that the OSCE was realistic and capable of providing accurate assessments. The OSCE provides an opportunity to systematically sample the different subdomains of Quality Improvement. Furthermore, the OSCE provides an opportunity for the demonstration of skills rather than the testing of knowledge alone, thus making it a potentially powerful assessment tool for SBP and PBLI. The study OSCE was well suited to assess SBP and PBLI. The evidence gathered through this study lays the foundation for future validation work.

Effecting the sixth core competency: a project-based curriculum

In agreement with the Accreditation Council for Graduate Medical Education guidelines, a systems-based practice (SBP) curriculum was implemented to provide a hands-on, team-based experience, while providing an opportunity to contribute to quality improvement, and to develop a method to assess residents' understanding of SBP. During departmental conferences, issues affecting our health care operations were identified. Seven teams were formed and the actionable items were investigated. The salient issues and potential solutions were presented to the department. This project resulted in the development of tools designed to assess competency in SBP, communication skills, and professionalism. Completion of a pre- and posttest and annual oral examination questions revealed a significant improvement in the comprehension of SBP. This project served as an effective educational forum for the competencies of SBP, communication skills, and professionalism. This initiative also offered improvement of patient care and/or educating peer providers, thereby fulfilling the goal of SBP in the process of education.

Teaching and Evaluating Group Competency in Systems-Based Practice in Anesthesiology

Teaching and assessment of the systems-based practice competency has been problematic in hospital-based specialties such as anesthesiology. We developed a method to teach systems-based practice with collaborative team projects. The outcome was assessed with a tool that focused on group attributes. Resident teams chose projects that focused on the health care system. Projects included economic analyses, safety initiatives, process analyses, and policy revisions. Projects were presented by groups in poster discussion sessions. The educational program was evaluated using five criteria: implementation, awareness and acceptance in the organization, utility, sustainability, and diffusion to other programs. The plan was implemented in 2005 and remains a required part of the resident curriculum. Key hospital and medical school leaders in our health care system participated in projects. Interdisciplinary collaboration occurred with multiple clinical departments. Nine projects performed economic analysis, 5 involved safety initiatives, 10 performed process analysis and recommended change, and 4 affected policy change in the institution. The program has been sustainable and has been effective in creating multidisciplinary institutional policy. We developed an innovative method to teach systems-based practice through a team-based project initiative. The projects appear to have had a positive impact on our health care organization. Our assessment tool for the project evaluated team, rather than individual, performance, which is crucial in this competency.

The Ambulatory Long Block: A Systems-Based Practice Innovation

Everyone in healthcare really has two jobs when they come to work every day: to do their work and to improve it [1]. —Paul Batalden and Frank Davidoff The Accreditation Council for Graduate Medical Education (ACGME) has defined competency in systems-based practice as "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" [2]. Applying this definition, residents are expected to:

Validation of a Method for Assessing Resident Physicians’ Quality Improvement Proposals

Residency programs involve trainees in quality improvement (QI) projects to evaluate competency in systems-based practice and practice-based learning and improvement. Valid approaches to assess QI proposals are lacking. We developed an instrument for assessing resident QI proposals--the Quality Improvement Proposal Assessment Tool (QIPAT-7)-and determined its validity and reliability. QIPAT-7 content was initially obtained from a national panel of QI experts. Through an iterative process, the instrument was refined, pilot-tested, and revised. Seven raters used the instrument to assess 45 resident QI proposals. Principal factor analysis was used to explore the dimensionality of instrument scores. Cronbach's alpha and intraclass correlations were calculated to determine internal consistency and interrater reliability, respectively. QIPAT-7 items comprised a single factor (eigenvalue = 3.4) suggesting a single assessment dimension. Interrater reliability for each item (range 0.79 to 0.93) and internal consistency reliability among the items (Cronbach's alpha = 0.87) were high. This method for assessing resident physician QI proposals is supported by content and internal structure validity evidence. QIPAT-7 is a useful tool for assessing resident QI proposals. Future research should determine the reliability of QIPAT-7 scores in other residency and fellowship training programs. Correlations should also be made between assessment scores and criteria for QI proposal success such as implementation of QI proposals, resident scholarly productivity, and improved patient outcomes.

Web-Based Module to Train and Assess Competency in Systems-Based Practice (Out of Print)

OPEN ACCESSMay 25, 2007Web-Based Module to Train and Assess Competency in Systems-Based Practice (Out of Print) Patricia O'Sullivan, MD, Kathryn Agarwal, MD, Zaldy Tan, MD, Anne Fabiny, MD, David Fobert, Grace Huang, MD, Lori Newman, MA Patricia O'Sullivan, MD Harvard Medical School Google Scholar More articles by this author , Kathryn Agarwal, MD Harvard Medical School Google Scholar More articles by this author , Zaldy Tan, MD Harvard Medical School Google Scholar More articles by this author , Anne Fabiny, MD Harvard Medical School Google Scholar More articles by this author , David Fobert Harvard Medical School Google Scholar More articles by this author , Grace Huang, MD Harvard Medical School Google Scholar More articles by this author , Lori Newman, MA Harvard Medical School Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.619 SectionsAboutAbstract ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: The Accreditation Council for Graduate Medical Education defines systems-based practice as a residents' understanding of the health care system and their ability to efficiently and effectively utilize resources within this system. We developed this module to train medical residents in the delivery of optimal care to patients by helping them navigate the complex maze of health care resources and to make transitions of care more seamless. Methods: We created an interactive, web-based 30-minute module based on the story of an older patient who presents to an emergency room with focal weakness after a recent hospital stay. The key curricular components of this training module are: (1) the basic elements of Medicare and Medicaid, (2) the various levels of post-acute hospital care for older patients, and (3) the role of provider-to-provider and provider-to-patient communication in patient transitions of care, including the critical elements of an effective discharge summary. The vignette has been tailored to be applicable to multidisciplinary trainees. Interactive questions are embedded within the case to emphasize key teaching points while continuing to engage the learners. Results: We piloted this web-based module on trainees of the Harvard Geriatric Medicine Fellowship. Among the 10 fellows who participated, there was an average increase in score between pre- and posttests of 10.6% (from 79% to 90%). The module was well-received by the trainees, and we anticipate a greater improvement in performance among trainees who have never been trained in geriatric medicine. Discussion: Systems-based practice is difficult to teach. By creating and piloting this web-based module we hope to offer residency directors an effective and entertaining interactive tool which may be used in either a didactic or an individual setting. Geriatric medicine offers an ideal forum for such teaching. Educational Objectives By the end of this session, the learner will be able to: Understand the critical elements of an effective discharge summary.Understand how effective discharge communication improves patient outcomes.Familiarize themselves with the basic features of Medicare and Medicaid.Understand how the intensity of intervention and support varies depending on the site of care. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Web Link Access_619.pdf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2007 O'Sullivan et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsWeb-Based ModuleComputer-Based LearningDischarge SummaryUnited States Centers for Medicare and Medicaid ServicesDelivery of Healthcare Disclosures None to report. Funding/Support None to report. Prior Presentations Presented at: the 5th Harvard Medical School, Medical Education Day; November 7, 2006; Boston, Massacheusetts. Loading ...