One of the key components of the Accreditation Council for Graduate Medical Education (ACGME) Next Accreditation System is an enhanced resident education in patient safety, quality improvement, and cost containment under the rubric of Systems-Based Practice (SBP).

Quality Improvement

Specifically, the ACGME requires “one example and the outcome of a planned quality improvement activity or project in which at least one resident participated in the past year that required the resident to demonstrate an ability to analyze, improve and change practice or patient care. Describe planning, implementation, evaluation, and provisions of faculty support and supervision that guided this process”.

Patient Safety

Regarding patient safety, the ACGME requires a “description of a learning activity that demonstrates how the program supports the development of resident skills for identifying system errors. Important elements may include identified faculty to guide the activity, a mechanism to ensure active engagement by each resident, and evidence of experiential learning (not just a passive presence at conferences or meetings) in which residents participate in identifying a system problem or error and contribute to a potential solution. Additional documentation would be the written goals and objectives for this learning activity and how residents are assessed. Aggregated resident outcomes may be in the form of the percentage of residents that completed a patient safety or other SBP project by the end of training, an annual list of improvements that resulted from such projects, etc. Site visitors may verify responses through interviews as needed”.

Cost Containment

Finally, the application of considerations of cost containment and risk-benefit analysis falls within the rubric of SBP. Residency programs are required to document engagement through “written goals and objectives for the learning activity, curriculum (didactic and experiential) that demonstrates the elements of SBP, and assessment of resident outcomes among the required learning activities that qualify as SBP…”.


Recognizing the challenge of incorporating these increasingly relevant concepts into traditional residency training curriculum, this website is intended to provide teachers, learners and program leaders with a single source for specific, concrete resources to facilitate formal engagement with quality improvement, patient safety, and cost containment projects.