Resources Relevant to the Implementation
of Core ACGME-Required Competencies

Module III
   Systems-based practice
          Module overview
Competency
      		 The ACGME’s Program Requirements for Residency Education in Allergy and Immunology define the competency of systems-based practice as, “manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value to the patient.”

The ACGME further defines a set of Allergy and immunology-specific competencies. These competencies are subsets of the core competencies and as such, may be considered embedded in them. The A/I-specific competencies that may relate to systems-based practice include the requirements to:
• “ Coordinate the care of patients, including the use of consultation.”

The Quadrad Report further amplifies the competency of systems-based practice by listing required skills, example components, and evaluation methods, as follows:
Required Skill Example Components Evaluation Method
Knowledge of practice and delivery systems
 Possess basic economic and business knowledge to function effectively in one’s own practice system
 Multiple choice written examination OR
Patient portfolios OR
Chart stimulated recall
Practice cost-effective care
 Know the relative costs of various medications used to treat asthma and rhinitis; ask patients how they pay for medications
 Checklist evaluation of live/recorded performance OR
Chart stimulated recall
Advocate for patients within the health care system
 Work to assure access to subspecialty consultations for patients with moderate to severe asthma
 360 Global rating evaluation OR
Patient satisfaction questionnaire OR
Chart stimulated recall
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Goals & objectives
 The following goals and objectives for systems-based learning have been articulated by A/I training program directors:

I. Exhibits awareness of and is responsive to systems of health care
     A. for example, demonstrates knowledge of HMO structure, Medicare/Medicaid, community resources

II. Advocates for patient within health care system
     A. for example, helping connect with appropriate resources; obtaining waiver for out-of-formulary prescription

III. Provides cost-effective medical care
     A. For example, knows relative costs of various prescriptions and considers as a factor when all else equal.
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