In This Issue

The inaugural issue of the Journal of Graduate Medical Education is devoted to the exploration of systems-based practice (SBP), with the lead editorial by Leach and Batalden (p 1) setting the stage. Articles are grouped under SBP, residency milestones, innovation in SBP and practice-based learning and improvement, and environment and context. In the section examining the SPB construct itself, Graham and colleagues (p 49) use structured interviews with 88 health care professionals to identify 6 resident roles with 35 specific underlying behavioral attributes. Their work produced a performance assessment instrument that reflected representations of SBP within a clinical context.

A sampling of articles is devoted to assessment, including objective structured clinical examinations (OSCEs) used in formal assessments at the beginning of residency and the formulation of developmental milestones. Centralized assessments of baseline residency competencies at 2 institutions showed variation, with average performance in communication skills approaching 90 percent, whereas patient care skills showed wide variability. Lypson and Wagner (p 21) report that skill deficits likely add to the stressful transition into residency, and that centralized assessment of residency entrants can enhance residents' preparation for clinical practice. The assessment can also be used to identify and address gaps in the undergraduate curriculum, and the model is of relevance to a wide range of skills that can be practiced and assessed via OSCEs. Short et al (p 30) describe another set of OSCEs for first-year residents, with stations including death notification, abdominal pain, transfusion consent, suture skills, wellness history, chest pain, altered mental status, and a literature search.

For the internal medicine milestone project, members of the community adopted the Dreyfus model as a framework for residency milestones. Green and colleagues (p 5) report that benefits include assessing valid data to inform decisions regarding promotion and readiness for independent practice, guiding curriculum development and selection of assessment strategies, offering resident benchmarks for self-directed assessment seeking, and assisting with remediation through explicit identification of specific deficits. In another article from the internal medicine community, Varney and colleagues (p 73) summarize the formulation of a developmental, criterion-referenced assessment method for residents.

Ducatman et al (p 37) explore how early resident evaluations predict acquisition of competency in pathology residents, and Boateng and colleagues describe a novel assessment approach based on grouping performance indicators into rubrics to measure the ACGME competencies in pediatrics residents. Several articles discuss simulation and computer-based enhancements to learning. Maizels and colleagues (p 109) describe an innovative effort to make operative field and other key elements of the procedure explicit through a computer-enhanced approach to visual learning; Wiet and colleagues (p xx) present enhanced surgical training in otolaryngology through use of simulation; and Eckert et al (p 89) describe the assessment of colonoscopy skills in a family medicine residency.

A fourth group of articles explores SBP in context, including the use and assessment of continuity teams in a family medicine residency (p 104), assessment of the patient safety culture in an internal medicine residency (p 139), and a curriculum and approaches for teaching error disclosure to obstetrics-gynecology residents (p 114).

In addition to the peer-reviewed sections, each issue of the Journal will feature a non–peer-reviewed section titled “ACGME News and Views,” with updates and summaries on topics important to graduate medical education. The inaugural issue features an editorial by Thomas Nasca, MD, MACP, prompted by Green and colleagues' work to summarize the development of the internal medicine milestones, along with an interview with Joseph Kolars, MD, about the value of international medical outreach. A short piece by ACGME staff describes the follow-up for residency programs with significant duty hour noncompliance identified via the resident survey.

Collectively, the works in this inaugural themed issue provide a rich picture of SBP as a multifaceted concept, with a range of applications in the real-life work of residents and practicing physicians, and the challenges of assessing the constructs, complex thinking, and clinical actions that underlie it.