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ACGME/IHI Joint Conference
Practice-based Learning and Improvement
Systems-based Practice
Abstract Form

Title:
The Mirror and The Village: A Method for Teaching Practice-Based Learning and Improvement and Systems-Based Practice
Presenters: Nicholas H. Fiebach, MD, Roy C. Ziegelstein, MD
Affiliation: Johns Hopkins Bayview Medical Center
Phone: (410) 550-0512
Fax: (410) 550-3403
E-mail: nfiebach@jhmi.edu
Address:
Division of General Internal Medicine B-2-N
4940 Eastern Avenue
Baltimore, MD 21224
 
Purpose: The competencies Practice-Based Learning and Improvement (PBLI) and Systems-Based Practice (SBP) may be conceptually difficult for both residents and faculty. Although tools for assessing these competencies have been suggested, methods for introducing these concepts are needed if PBLI and SBP are to be embraced and incorporated into lifelong education and practice.
 
Methodology: PBLI and SBP were introduced using the metaphors "The Mirror" and "It Takes a Village." Lectures were presented to residents and faculty to explain the objectives of these two competencies. In these presentations, PBLI was likened to holding a mirror up to ourselves to document, assess, and improve our practice. Specific tools for residents (e.g. morbidity and mortality morning reports, clinic chart self-audits, and residency learning portfolios) became "The Mirror" and allowed residents to compare their practices to guidelines and material learned in evidence-based medicine. SBP was introduced using Hillary Clinton's phrase, "It takes a village to raise a child" as a metaphor. The lectures noted the importance of non-physician members of the health care team and used changes in health care delivery (e.g. shorter lengths of stay, increasing use of subacute facilities) to highlight the importance of "The Village" in modern practice. Specific training activities (e.g. multidisciplinary patient care rounds and nursing evaluations, quality assurance-systems improvement exercises, and a hospital discharge follow-up project) emphasized the concept that the resident physician is one part of a system of care.
 
Results: A survey of residents demonstrated their agreement that weekly morbidity and mortality morning report, clinic chart self-audits, residency learning portfolios, and multidisciplinary rounds had helped to improve their proficiency in specific aspects of PBLI and SBP.
 
Conclusions: Preliminary results indicate that the concepts of PBLI and SBP can be introduced effectively in residency training by incorporating specific activities that address these competencies and by using the metaphors The Mirror and The Village to illustrate their importance.
 
Implications: Residency programs may use the metaphors The Mirror and The Village to introduce PBLI and SBP concepts and specific training activities.

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