Research Highlights Need for New Approaches toward Systems-based Practice (SBP) Resident Education

Kevin Black, M.D.

Kevin Black, M.D.

A health care provider’s ability to call on the resources of the wider health care system to provide effective, optimal patient care, has only recently been recognized as a key component of resident education. A 2010 national survey and follow-up focus groups of health care system stakeholders regarding SBP resident training conducted by Kevin Black, M.D. and Susanne Roberts, M.D., of Penn State Hershey Bone and Joint Institute, along with colleagues at the University of British Columbia, highlighted both progress and areas requiring improvement. Focus group results were presented as a poster at the June 2011 annual meeting of the American Orthopaedic Association in Boston, Massachusetts. The survey revealed improved efforts to educate residents about the broader health care system, including third-party payers, federal and state regulations, patient safety and alternate medical care facilities, but that what was taught was highly variable, and assessment of what was learned was severely lacking. The survey and focus groups also identified an important gap in resident SBP training–the ability of residents to communicate with and understand the needs of other health care professionals involved in patient care. With the increasing pace and complexity of medical care, marked by shorter patient stays, and patients who exhibit comorbidities, Black says, “one message became clear: orthopaedic residents (and faculty) need to better understand that they don’t provide health care in a vacuum and should develop insight into the needs of the entire professional team to provide high quality patient care.”In direct response to these findings, in July 2011, the orthopaedic residency training program at Penn State Hershey launched a first-in-the-nation, experiential SBP training initiative. In addition to traditional paper and pencil SBP teaching and assessment tools, incoming residents now shadow patients throughout their hospital stay, allowing them to gain the perspective of the patient beyond direct orthopaedic care and to observe interactions of a broad spectrum of health care providers with the patient and with each other. Following this experience, resident SBP performance will be evaluated by faculty and other health care team members (eg, nurses, social workers, administrators) on the basis of demonstrating awareness of the full spectrum of direct patient care, including hand-offs, discharge planning, and post-discharge care options. Black notes that the program is in its infancy but “it has never been more important for health care to be practiced by a team of individuals working together, as opposed to the surgeon whose reputation for excellence lies only in what he accomplishes in the operating room” and “ultimately, this is about patient quality of care.” The findings of the 2010 national SBP survey have been submitted for publication in a peer-reviewed journal and Black hopes they will serve as an impetus for development of experiential resident SBP training programs throughout the United States.


Kevin Black, M.D.

C. McCollister Evarts Professor and Chair, Orthopaedics and Rehabilitation

  • Director, Penn State Hershey Bone and Joint Institute
  • Fellowship: Sports medicine, Cleveland Clinic Foundation, Cleveland, Ohio
  • Residency: Orthopaedic surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York
  • Internship: Orthopaedic surgery, New York University Medical Center, New York, New York
  • Medical School: University of Rochester School of Medicine and Dentistry, Rochester, New York

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