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System Analysis of Graduate Medical Education Processes


As medicine becomes more advanced and graduate medical education (GME) more densely packed, there is increasing recognition of the need to re-examine resident training processes, methods, and content.


By example, the Accreditation Council for Graduate Medical Education (ACGME) recently released its new Clinical Learning Environment Review guidelines and a call for proposals for innovative redesign of GME. In support of this, this project conducted normative work to apply systems engineering to define and analyzed current GME systems from a formal systems design perspective.


The project’s aim was to assess the current state of GME using systems engineering tools in order to identify areas for re-design to optimize resident education and patient care. Through stakeholder interviews and process observations, a team of systems and industrial engineers assessed the current state of daily processes in internal medicine residency primarily

using the following four tools: (1) Process maps, (2) Systems Engineering Initiative for Patient Safety SEIPS, (3) Failure mode and effects analysis (FMEA), and (4) Functional Resonance Analysis Method (FRAM).


Project Team

All four tools combined provided insightful information useful to process redesign. Process maps illustrated the general flow of a resident’s activities and that a high degree of variation occurs day-to-day. The SEIPS model identified five main areas of concern in GME: heavy workloads, lack of communication, lack of reflection learning, variable training, and inefficient exchange of information practices. FMEA identified 18 primary failure modes with 21 effects and 43 causes. The medical team identified more care-related failures than learning-related failures and rated them with higher severity. FRAM provided insights into the interconnectedness of GME functions. These findings will inform future efforts of GME redesign.

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