System based practice: a concept analysis

Abstract

Introduction: Systems-Based Practice (SBP) is one of the sixcompetencies introduced by the ACGME for physicians toprovide high quality of care and also the most challenging of themin performance, training, and evaluation of medical students.This concept analysis clarifies the concept of SBP by identifyingits components to make it possible to differentiate it from othersimilar concepts. For proper training of SBP and to ensure thesecompetencies in physicians, it is necessary to have an operationaldefinition, and SBP’s components must be precisely defined inorder to provide valid and reliable assessment tools.Methods: Walker & Avant’s approach to concept analysis wasperformed in eight stages: choosing a concept, determining thepurpose of analysis, identifying all uses of the concept, definingattributes, identifying a model case, identifying borderline, related,and contrary cases, identifying antecedents and consequences,and defining empirical referents.Results: Based on the analysis undertaken, the attributes ofSBP includes knowledge of the system, balanced decisionbetween patients’ need and system goals, effective role playingin interprofessional health care team, system level of healthadvocacy, and acting for system improvement. System thinkingand a functional system are antecedents and system goals areconsequences. A case model, as well as border, and contrary casesof SBP, has been introduced.Conclusion: The identification of SBP attributes in this studycontributes to the body of knowledge in SBP and reduces theambiguity of this concept to make it possible for applying it intraining of different medical specialties. Also, it would be possibleto develop and use more precise tools to evaluate SBP competencyby using empirical referents of the analysis.Keywords: Accreditation; Medical education; Competency-based education