Bowe Constance M, Armstrong Elizabeth
C.M. Bowe is codirector, Systems Approach to Assessment in Health Professions Education, Harvard Macy Institute, senior consultant, Partners Health Care International, and professor emeritus, Clinical Neurology, University of California, Davis, School of Medicine, Sacramento, California. E. Armstrong is director, Harvard Macy Institute, and clinical professor, Pediatrics, Harvard Medical School, Boston, Massachusetts.
Acad Med. 2017 May;92(5):585-592. doi: 10.1097/ACM.0000000000001321.
Viewing health care from a systems perspective-that is, "a collection of different things which, working together, produce a result not achievable by the things alone"-raises awareness of the complex interrelationships involved in meeting society's goals for accessible, cost-effective, high-quality health care. This perspective also emphasizes the far-reaching consequences of changes in one sector of a system on other components' performance. Medical education promotes this holistic view of health care in its curricula and competency requirements for graduation at the undergraduate and graduate training levels. But how completely does medical education apply a systems lens to itself?The continuum of medical training has undergone a series of changes that have moved it more closely to a systems organizational model. Competency assessment criteria have been expanded and more explicitly defined for learners at all levels of training. Outcomes data, in multiple domains, are monitored by external reviewers for program accreditation. However, translating increasing amounts of individual outcomes into actionable intelligence for decision making poses a formidable information management challenge.Assessment in systems is designed to impart a "big picture" of overall system performance through the synthesis, analysis, and interpretation of outcomes data to provide actionable information for continuous systems improvement, innovation, and long-term planning. A systems-based framework is presented for use across the medical education continuum to facilitate timely improvements in individual curriculum components, continuous improvement in overall program performance, and program decision making on changes required to better address society's health care needs.
从系统角度看待医疗保健——也就是说，“由不同事物组成的集合，这些事物共同作用产生单独的事物无法实现的结果”——提高了人们对实现社会可及、经济高效、高质量医疗保健目标所涉及的复杂相互关系的认识。这种观点还强调了系统的一个部门的变化对其他组成部分绩效的深远影响。医学教育在其本科和研究生培训阶段的课程和毕业能力要求中推广了这种整体的医疗保健观。但是医学教育在多大程度上完全将系统视角应用于自身呢？医学培训的连续过程经历了一系列变化，使其更接近系统组织模式。能力评估标准已经扩大，并且针对各级培训的学习者进行了更明确的界定。多个领域的结果数据由外部评审员监测，以进行项目认证。然而，将越来越多的个人结果转化为可用于决策的可操作情报，带来了巨大的信息管理挑战。系统评估旨在通过对结果数据的综合、分析和解释，给出整体系统性能的“全景”，以提供可操作信息，促进系统持续改进、创新和长期规划。本文提出了一个基于系统的框架，用于贯穿医学教育的连续过程，以促进各个课程组成部分的及时改进、整体项目绩效的持续提升，以及就为更好地满足社会医疗保健需求所需的变革进行项目决策。
