Table 1 Sub-competencies for science of health care delivery milestones in undergraduate medical education

Systems-Based Practice

Develops skills in advocacy theory, execution and communication in order to advocate effectively for individual patients and at-risk populations

• Advocates for patient access to community resources (EPA 9)

Partners with the community to improve individual and population health

• Understands that population health issues affect the health of patients and therefore identifies sources of information about the needs and resources of the community; Interacts and begins to work collaboratively with community agencies, professionals, and others to address population health issues (EPA 3 and 7)

Defines value in health care and applies high value care strategies for individual patients and populations

• Incorporate cost awareness and principles of cost-effectiveness and pre-test/post-test probability in developing diagnostic plans (EPA 3)

Identifies systems failures and errors and contributes to a culture of safety and quality improvement

• Recognize and avoid errors by using safety alerts (e.g., drug-drug interactions) and information resources to place the correct order and maximize therapeutic benefit and safety for patients (EPA 4)

• Identify system failures and contribute to a culture of safety and improvement (EPA 13)

Describes United States’ healthcare financing and related effects on patient care and quality

• None

Analyzes current United States’ healthcare policy and its impact on health care delivery systems

• None

Describes the roles of clinical informatics, healthcare IT, and technology assessment in improving patient outcomes

• Uses tools and information technology to support decision making and adopt strategies to decrease cost and risk to individuals (EPA 3)

• Compose orders efficiently and effectively, such as by identifying the correct admission order set, selecting the correct fluid and electrolyte replacement orders, and recognizing the needs for deviations from standard order sets (EPA 4)

• Identify and demonstrate the use of information technology to access accurate and reliable online medical information (EPA 7)

• Document, and update, an electronic handover tool (EPA 8)

Interpersonal and Communication Skills

Develops patient-centered perspective and interviewing skills

• Demonstrate patient-centered interview skills (EPA 1)

• Apply the primary findings of one’s information search to an individual patient or panel of patients (EPA 7)

Collaborates as a member of an inter-professional team and demonstrates effective, team-based patient care

• Demonstrates an understanding of the roles of various team members by interacting with appropriate team members to accomplish assignments. Actively works to integrate into team function and meet or exceed the expectations of his or her given role (EPA 9)

Effectively leads an intra−/ inter-professional team in the clinical, educational, or research setting

• Collaborate as a member of an inter-professional team (EPA 9)

Effectively gives and receives a patient handover to transition care responsibility

• Give or receive a patient handover to transition care responsibility (EPA 8)

Professionalism

Individualizes care by engaging patients in shared decision making and motivating behavior change

• Elicit and take into account patient preferences in making recommendations (EPA 3)

• Discuss the planned orders and prescriptions… with patients and families and use a nonjudgmental approach to elicit health beliefs (EPA 4)

• Document patient preferences to allow their incorporation into clinical decision making (EPA 5)

Practices contextual and cultural humility, curiosity, and awareness

• Consider cultural and other factors that may influence the patient’s description of symptoms; Demonstrate cultural awareness and humility (EPA 1)

Practice-Based Learning and Improvement

Forms clinical questions and retrieves, appraises and assimilates evidence from the scientific literature

• Form clinical questions and retrieve evidence to advance patient care (EPA 7)

Patient Care

Applies principles of preventive health and strategies for population health management

• Understands that population health issues affect the health of patients and therefore identifies sources of information about the needs and resources of the community (EPA 3 and 7)

• Apply the primary findings of one’s information search to an individual patient or panel of patients (EPA 7)