Practice Based Learning and Improvement (PBLI)
The PBLI competency is characterized by the opportunity of develop the habit and responsibility for lifelong learning. It is the bridge between learning and application to patient care. According to Lynch, the rationale for PBLI stems from the following assertions:
1. Physicians should have systematic approaches for monitoring and improving their practice.
2. Physicians must be able to recognize the need for positive change and instigate it rather than simply react to changes made by others.
3. Positive changes in small systems, such as an individual physician’s practice, may positively affect larger systems.
The competency of PBLI most directly interfaces with Continuing Medical Education with an emphasis on recognizing learning needs in practice leading to self-directed learning with content, learning methods, and learning resources selected specifically to maintain or improve knowledge, skill and attitudes needed daily in clinical practice. CME links directly to performance improvement and point of care learning. Improvement, thus, derives from learning that occurs in the practice setting where care is provided. PBLI is embedded in every medical practice. Issues important to developing an understanding of PBLI are reflection on the practice setting, stakeholders’ expectations, practice as a system, measurement of performance, information mastery, and physician leadership (Leist and Pennington).
ACGME expectations
As delineated by the ACGME, to achieve competency in PBLI, residents must be able to investigate, appraise, and assimilate scientific evidence. Residents are expected to:
1. Analyze practice experience and perform practice-based improvement activities using a systematic methodology
2. Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems
3. Obtain and use information about their own population of patients and the larger population from which their patients are drawn
4. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness
5. Use information technology to manage information, access online medical information, and support their own education
6. Facilitate the learning of students and other healthcare professionals.
You have earlier seen the Dreyfus classification of skill development levels. At the completion of residency, the physician should have developed the essential skills to maintain professional development: Self- assessment and self-directed learning.
Experiential learning
The following is an experiential learning model adapted from Kolb D. Experiential Learning. Prentice Hall PTR, 1984.