Systems-Based Practice Core Competency: A Survey of Physicians' Perspectives

Background: Systems-Based Practice (SBP) has been a core competency in the United States Graduate Medical Education (GME) since 1999, but little is known about physicians' attitudes toward and skills in SBP. Methods: The aim of this study was to examine resident and GME faculty physicians' perceptions of their engagement, responsibility, and skills in SBP and opportunities to engage in SBP within the clinical workplace. A cross-sectional survey was conducted from May to June 2021 of 6,899 resident and GME faculty physicians across 10 health systems. The survey used Likert-scale questions to assess participants' perceptions across four domains, including engagement in SBP, responsibility for SBP, self-perceived SBP knowledge and skills, and affordances in the clinical environment to learn SBP. Results: The survey response rate was 21% (n=1,436). Most respondents were engaged in SBP and believed it was their responsibility to engage in SBP. The minority of respondents reported having adequate skills in several core SBP domains, including contributing to system-level improvements (n=576; 40.1%), addressing social determinants of health (n=530; 36.9%), and engaging in population health management (n=348; 24.2%). Organizational affordances had lower average scores. Conclusions: Resident and GME faculty physicians seem to endorse a high degree of responsibility for and engagement in SBP while identifying substantial self-perceived skill deficits in SBP. Participants reported insufficient affordances in the clinical environment to develop several SBP sub-competencies.