EDUCATIONAL ADVANCES Addressing the Systems-based Practice Core Competency: A Simulation-based Curriculum Ernest E. Wang, MD, John A. Vozenilek, MD Abstract Systems-based practice is one of the six core competencies implemented by the Accreditation Council for Graduate Medical Education to direct residency educational outcome assessment and accreditation. Emergency medicine–specific systems-based practice criteria have been described to define the expected knowledge and skill sets pertinent to emer- gency medicine practitioners. High-fidelity patient simula- tion is increasingly used in graduate medical education to augment case-based learning. The authors describe a simula- tion-based curriculum to address the emergency medicine– specific systems-based practice core competency. Key words: emergency medicine; computer-assisted instruction; patient simulation internship and residency teaching; clinical com- petence. ACADEMIC EMERGENCY MEDICINE 2005; nn:nn–nn. In 1999, the Accreditation Council for Graduate Med- ical Education (ACGME) endorsed the implementa- tion of six general core competencies ‘‘in a long-term effort designed to emphasize educational outcome assessment in residency programs and in the accred- itation process.’’ 1 Accredited residency programs must require their residents to develop the competencies to the level expected of a new practitioner. ‘‘Toward this end, programs must define the specific knowledge, skills, and attitudes required and provide educa- tional experiences as needed in order for their resi- dents to demonstrate the competencies.’’ The focus of the systems-based practice (SBP) com- petency is to ensure that residency graduates demon- strate ‘‘an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to pro- vide care that is of optimal value.’’ 1 The provisions of this core competency require that residents under- stand the relationship of their individual medical practice to the context of the health care system as a whole. In addition, residents are expected to learn how to practice cost-effective health care, how to effi- ciently allocate resources, and how to deal with system complexities such that the quality of patient care is not compromised. The detailed cross-specialty ACGME system-based practice criteria can be refer- enced at http://www.acgme.org/outcome/comp/ compFull.asp. 1 The specialty of emergency medicine (EM), more than any other field in medicine, requires that prac- titioners have expertise in SBP because emergency physicians evaluate and treat the entire spectrum of the patient population and interact with all the major services within the hospital. Furthermore, emergency physicians are involved with every significant seg- ment of the health care delivery system on a daily basis, from out-of-hospital/interfacility care to pri- mary patient care, management, consultation, and disposition. EM-specific expertise is also required in the areas of multitasking, team management, medi- colegal issues with respect to the Emergency Medical Treatment and Active Labor Act and leaving against medical advice, modifying factors to health care (such as night and weekend resource availability, age, gen- der, ethnicity, communication, socioeconomic status, and other barriers to health care), disaster manage- ment, and patient education. In an effort to stay ahead of the curve, Dyne et al. published EM-specific defini- tions of the ACGME SBP core competency based on the Model of the Clinical Practice of Emergency Medicine. 2 High-fidelity simulation (HFS) has been used as a tool for teaching and potentially evaluating some of the ACGME competencies. 3 Simulation is endorsed by the ACGME as a valid tool for training and assess- ment of resident performance with respect to the core competencies. The ACGME provides a ‘‘toolbox’’ of acceptable assessment methods for educators to use to address the competencies 4 : The key attributes of simulations are that: they incor- porate a wide array of options resembling reality, allow examinees to reason through a clinical problem with little From the Division of Emergency Medicine, Evanston Hospital (EEW), Evanston, IL; and Northwestern University Emergency Medicine Residency Program (JAV), Evanston, IL. Received March 30, 2005; revisions received June 6, 2005, and June 21, 2005; accepted June 25, 2005. Address for correspondence and reprints: Ernest E. Wang, MD, Di- vision of Emergency Medicine, Evanston Northwestern Healthcare, Evanston Hospital, 2650 Ridge Ave., Evanston, IL 60201. E-mail: ernestwangmd@yahoo.com. doi:10.1197/j.aem.2005.06.026 ARTICLE IN PRESS ACAD EMERG MED d Month 2005, Vol. nn, No. n d www.aemj.org 1