At the core of proficiency in Practice-based Learning and Improvement (PBLI) is lifelong learning and quality improvement.
These require skills in and the practice of self evaluation and reflection to engage in habitual Plan-Do-Study-Act cycles for quality improvement at the individual practice level, as well as skills and practice using Evidence-based Medicine (EBM). In addition, residents must learn and practice teaching skills to enable them to effectively educate patients, families, students, residents and other health professionals.
Some programs have identified tools to support development of self assessment and reflection skills and habits. Other tools might address attributes important to the practicing physician, such as time management, stress management, or elements for the competencies. Or, a simple prompt to think about what went well, what didn't, and what the resident would like to do differently can help residents to think beyond context and to share meaning. Effective use of such tools involves assessment by both the residents (self assessment) and faculty member, as well as subsequent discussion of strengths and areas for improvement that emerge. We know that 'we don't know what we don't know' so discussing differences in self-assessed abilities and faculty member-assessed abilities is a good way to gain awareness and develop better self-assessment skills. Reflection is critical for gaining greater self knowledge (link to professionalism); it functions as a personal PDSA cycle (establish goals, monitor progress, question things as they happen, assess what is/is not working).
Didactic training for EBM-related skills will help residents develop the needed skills and habits: locating information, using information technology, appraising information, assimilating evidence (from scientific studies as well as practice data), and applying information to patient care. Resources for accomplishing this may include library professionals and a variety of articles, books, and learning modules. In addition, residents should have the opportunity to apply these skills in a structure activity such as journal club that is evaluated using a tool structured to provide meaningful feedback. Faculty oversight of this activity as teachers, mentors, and role models will aid resident development of these skills and habits.
Quality improvement (QI) skills may be obtained by active participation on a QI committee (planning; implementation; analysis of an intervention on a practice outcome; incorporation into practice if improvement has occurred; initiation of a new PDSA cycle if improvement has not occurred). Different specialties may have specific expectations regarding requirements for quality improvement related to PBLI.
A final area addressed by this competency domain is teaching skills used for the education of patients, families, students, residents, and other health professionals. While this overlaps the Interpersonal and Communication Skills domain, this requirement addresses the need for specific teaching skills. This is linked to practice improvement, because patients who lack a clear understanding of their condition and how they can participate in self-care because their physician has educated them effectively. Similarly, physicians who are able to effectively educate consulting physicians rather than just asking for a yes/no answer are more likely to get the information they need to provide better care.
Competency information taken from the
ACGME web site on Practice Based Learning and Improvement.
Content pages that correspond to the Practice Based Learning and Improvement competency: