A resident's reflections on becoming an agent of curricular change.

摘要

The American health care system is complex and constantly changing. In collaborating with teams of health care providers and administrators, postgraduate medical trainees can begin to reflect upon and understand their roles within the larger system. Teaching residents the requisite skills to make improvements in the systems in which they work and empowering them to instigate these transformations may improve patient care and help in the development of doctor leaders. The Accreditation Council for Graduate Medical Education (ACGME) has recognised the need for residency programmes to restructure their curricula to include these skills. In 2003, the Achieving Competence Today (ACT) curriculum was created through the Partnerships for Quality Education, a national initiative funded by the Robert Wood Johnson Foundation. Each year, selected residents participate in an intensive, 1-month elective, which immerses them in systems-based practice (SBP) and practice-based learning and improvement (PBLI) concepts and practical experiences. These ACT residents then become agents of change by creating new curricula for their fellow trainees. This paper describes one resident's personal experience with the ACT programme and illustrates how the competencies of SBP and PBLI were concretised in an internal medicine residency programme. This story is presented through the personal narrative of the case resident and highlights the lessons learned and the resident's reflections (which will be italicised).5 Section 1 describes the ACT elective. Section 2 focuses on the process of curricular reform. It is hoped that recounting this experience can serve to present a model for other programmes wishing to accomplish similar successful transformations.