The outcomes card. Development of a systems-based practice educational tool

J Gen Intern Med. 2005 Aug;20(8):769-71. doi: 10.1111/j.1525-1497.2005.0168.x.


Introduction: The Accreditation Council for Graduate Medical Education requires competence in systems-based practice (SBP) demonstrating understanding of complex interactions between systems of care and its impact upon care delivery. Patient safety is a useful vehicle to facilitate learning about these interactions.

Aim: Develop an educational tool, Outcomes Card (OC), to reinforce core concepts of SBP.

Setting: Urgent Care Center at Louis Stokes Cleveland Department of Veterans Affairs Medical Center.

Program description: Pilot study of an educational intervention for residents that included patient safety didactic sessions and analysis of 2 self-identified clinical cases using the OC. Residents entered the following information on the OC: case description, type of event (error, near miss, and/or adverse event), error type(s), systems, and system failures.

Program evaluation: Two reviewers independently analyzed 98 cards completed during 60 two-week trainee rotations (81.7% return rate). Interrater reliability for error types between residents and physician supervisor and between reviewers was excellent (kappa=0.88 and 0.95, respectively), and for system identification was good (kappa=0.66 and 0.68, respectively). The self-assessment survey (56.6% return rate) suggests that residents improved their knowledge of patient safety and had positive attitudes about the curriculum.

Discussion: This pilot study suggests that OCs are feasible and reliable educational tools for enhancing competence in SBP.

MeSH terms

  • Adult
  • Clinical Competence* / standards
  • Curriculum
  • Humans
  • Internship and Residency* / standards
  • Medical Errors
  • Models, Educational
  • Outcome Assessment, Health Care*
  • Pilot Projects