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

Academic Psychiatry : the Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry
Michael WeinbergJules M Ranz

Abstract

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

References

Jul 10, 2003·Psychiatric Services : a Journal of the American Psychiatric Association·Jeffrey A Buck
Nov 7, 2006·Psychiatric Services : a Journal of the American Psychiatric Association·Jules M RanzAnn Sullivan
Nov 13, 2008·Community Mental Health Journal·Kimberley R IsettJoseph P Morrissey
Nov 17, 2012·Academic Psychiatry : the Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry·Jules M RanzMichael J Vergare
Feb 27, 2014·Academic Psychiatry : the Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry·Joanna L FriedJules M Ranz
Apr 29, 2014·Academic Psychiatry : the Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry·Melissa R ArbuckleUNKNOWN Mental Health Services Committee of the Group for the Advancement of Psychiatry
Mar 3, 2015·Psychiatric Services : a Journal of the American Psychiatric Association·Julie SeibertMaryam Tabrizi
Jul 12, 2016·JAMA : the Journal of the American Medical Association·Peter R Orszag

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Citations

Mar 27, 2020·Academic Psychiatry : the Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry·Melissa R ArbuckleDavid A Stern

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