Putting residents in the office: An effective method to teach the systems-based practice competency

Marisa Pulcrano, A. Alfred Chahine*, Amanda Saratsis, Jamie Divine-Cadavid, Vinod Narra, Stephen R T Evans

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Objectives Systems-based practice (SBP) was 1 of 6 core competencies established by the Accreditation Council for Graduate Medical Education and has proven to be one of the most difficult to effectively implement. This pilot study presents an immersion workshop as an effective tool to teach the SBP competency in a way that could easily be integrated into a residency curriculum. Design In 2006, 16 surgical residents rotated through 3 stations for 30 minutes each: coding and billing, scheduling operations and return appointments, and patient check-in. Participants were administered a pretest and posttest questionnaire evaluating their knowledge of SBP, and were asked to evaluate the workshop. Setting Outpatient clinic at MedStar Georgetown University Hospital, Washington, DC. Participants Residents in the general surgery residency training program at MedStar Georgetown University Hospital. Results Most residents (62.5%) improved their score after the workshop, whereas 31.25% showed no change and 6.25% demonstrated a decrease in score. Overall within their training levels, all groups demonstrated an increase in mean test score. Postgraduate year-2 residents demonstrated the greatest change in mean score (20%), whereas postgraduate year-4 residents demonstrated the smallest change in mean score (3.3%). Conclusions An immersion workshop where general surgery residents gained direct exposure to SBP concepts in situ was an effective and practical method of integrating this core competency into the residency curriculum. Such a workshop could complement more formal didactic teaching and be easily incorporated into the curriculum. For example, this workshop could be integrated into the ambulatory care requirement that each resident must fulfill as part of their clinical training.

Original languageEnglish (US)
Article number983
Pages (from-to)286-290
Number of pages5
JournalJournal of Surgical Education
Issue number2
StatePublished - Mar 1 2015


  • competencies
  • general surgery residency
  • graduate medical education
  • systems-based practice

ASJC Scopus subject areas

  • Surgery
  • Education


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