Laura Culver Edgar¹
Kenji Yamazaki² and Eric Holmboe¹
1 ACGME
2 Accreditation Council For Graduate Medical Education

The Accreditation Council for Graduate medical Education (ACGME) accredits over 12,000 post-graduate medical education (PGME) programs in the USA and ACGME-International accredits nearly 200 programs in 11 countries. Systems-based practice (SBP) is a core competency for these programs. This competency ensures physicians are prepared to work in complex care systems, identify necessary resources, provide transitions of care, and other tasks while ensuring patient safety and continual practice improvement. To ensure development of this competency, PGME learners are assessed against developmental descriptors specific to SBP throughout their training. These assessments are submitted by all PGME programs to ACGME and ACGME-I biannually. The preparation and assessment of future physicians in systems-based practice is codified through a set of developmental trajectories called Milestones organized by competency and subcompetency. The Milestones are described from Level 1 (novice), Level 2 (advanced beginner), Level 3 (competent), Level 4 (proficient), and Level 5 (expert). It is intended that PGME physicians will achieve these levels at various times during their training programs. The subcompetencies include: patient safety and quality improvement, coordination of care, transitions of care, local population health, health care cost/payment, and physician roles in healthcare systems. 

However, implementation around these subcompetencies remains a challenge due to multiple factors including: 1) lack of programmatic and faculty expertise in SBP; 2) difficulties in designing and implementing curricular experiences; 3) lack or ineffective use of assessment methods. 

PGME leadership continues to struggle with assessing competencies related to the working in the healthcare system. By having more explicit definitions and descriptions of these competencies we can plan better assessment and ongoing training. 

The objectives are to: develop an understanding of the identified subcompetencies; identify how they are assessed (Milestones); using data collected from ACGME and ACGME-I accredited programs demonstrate how PGME physicians grow in these areas – data will include national box plots by post graduate year and validity data regarding longitudinal learning trajectories by subcompetency. Important validity studies will be highlighted; and finally, the panelists will discuss how the SBP competency data indicates the substantial variation in the preparation of PGME physicians entering unsupervised practice. 

Who should participate?
ALL


Level of workshop
ALL 

Despite the clear need for all physicians to possess these key abilities to meet population and healthcare system needs, the data demonstrates on-going global challenges with these important concepts and abilities. The Milestones data clarifies these challenges, supporting changes in curriculum and assessment in PGME training programs. 

We must also recognize the interdependence of physicians' abilities with the challenging hospital environment. Hospitals will need to help all professionals learn and apply systems- thinking, finding ways to reduce unnecessary complexity in clinical care, increasing learning opportunities for PGME physicians to better prepare them for practice, and work as interprofessional teams to ensure that PGME physicians of today are able to thrive and succeed as partners tomorrow. 

References (maximum three)