The creation and evaluation of a systems-based practice/managed care curriculum in a primary care internal medicine residency program

Background: A systems-based practice (SBP) is defined by the Accreditation Council for Graduate Medical Education as "manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value" (1). We developed a systems-based practice/managed care curriculum in a monthly workshop format, and integrated it into our Mount Sinai School of Medicine (Elmhurst) program in internal medicine. We evaluated the success of this workshop by utilizing both subjective and objective assessments of knowledge obtained by medical residents in attendance. Methods: We surveyed our medical residents in order to assess their educational experiences in the workshop with regard to their comfort level with the use, application, and discussion with patients of 13 concepts central to current SBP issues, as well as to what extent they believed the workshop improved or enhanced this level of comfort (subjective assessment). Residents then completed10 true/false questions designed to measure their understanding of key SBP points (objective assessment). Their performance on this section was evaluated based on their individual experiences with the workshop. Results: The mean comfort level for all 13 SBP topics increased via Likert scale from 2.79 before participation in the workshop, to 3.51 after participation. The mean comfort level improved for 11 out of the 13 topics (only "Medicaid" and "Medicare" did not show this improvement). Results of the 10-question test revealed that the mean percent correct score was lowest for those who did not attend the workshop (60% for interns and 67% for residents), intermediate for those who attended once (78%), and highest for those who attended more than once (84%). Of those who attended at least once, senior residents scored slightly lower than interns and junior residents (78% vs. 81%); the difference was not statistically significant. Conclusion: The inclusion of an SBP curriculum can increase internal medicine residents' understanding of, and comfort with, important topics in managed care and SBP.