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Broadening the Lens of System-Based Practice: From Micro to Macro and Basic to Complex in Residency Training

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Abstract

Objective

This paper aimed to develop a model for understanding the various dimensions of system-based practice (SBP) and determine the extent to which psychiatry residents perform behaviors along these dimensions.

Methods

Sixty-one supervisors from seven psychiatry programs rated resident performance of SBP behaviors using a 60-item instrument. Multi-dimensional scaling and cluster analysis were conducted to determine how the instrument items related to one another and the larger concept of SBP. Average supervisor ratings between clusters were compared to determine resident performance along the identified SBP dimensions.

Results

The data supports a model of SBP defined along two dimensions: (1) from micro (patient) to macro (population-based) interventions and (2) from low to high system complexity. Residents were more likely to perform behaviors at the patient level compared to those at the population-based level.

Conclusions

Training in SBP remains predominately focused on the doctor-patient level and not the greater system of health-care delivery.

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Acknowledgments

All research carried out under the auspice of Columbia University, St. Luke’s Roosevelt Hospital, University of California—Los Angeles, Cornell University, University of Pittsburgh, NYU, and Bronx Psychiatric Center.

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Authors and Affiliations

  1. Columbia University Department of Psychiatry, New York, NY, USA

    Michael Weinberg, Melissa R. Arbuckle & Jules M. Ranz

Authors
  1. Michael Weinberg
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  2. Melissa R. Arbuckle
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  3. Jules M. Ranz
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Corresponding author

Correspondence to Michael Weinberg.

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IRB approval was obtained from each site.

Disclosures

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Weinberg, M., Arbuckle, M.R. & Ranz, J.M. Broadening the Lens of System-Based Practice: From Micro to Macro and Basic to Complex in Residency Training. Acad Psychiatry 42, 212–216 (2018). https://doi.org/10.1007/s40596-017-0716-2

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  • DOI: https://doi.org/10.1007/s40596-017-0716-2

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