Learning: Contemplating the unexamined core of Learning Health Systems.

Introduction: The current Learning Health Systems literature affords insufficient attention to the process of learning. In response, Billings Clinic focused on how to advance its learning capabilities and subsequently to contribute new insights into the process of learning to the LHS literature.

Methods: An environmental scan was conducted, including the grey literature (eg, technical reports and white papers) and peer-reviewed research publications.

A multisite, multistakeholder validation of the Accreditation Council for Graduate Medical Education competencies.

Purpose: The Accreditation Council for Graduate Medical Education's (ACGME's) six-competency framework has not been validated across multiple stakeholders and sites. The objective of this study was to perform a multisite validation with five stakeholder groups.

Method: This was a cross-sectional, observational study carried out from October to December, 2011, in the internal medicine residency continuity clinics of eight internal medicine residency programs in the Pacific Northwest, including a VA, two academic medical centers, a military medical center, and four private hospitals.

Making sense: duty hours, work flow, and waste in graduate medical education.

Parsimony, and not industry, is the immediate cause of the increase of capital. Industry, indeed, provides the subject which parsimony accumulates. But whatever industry might acquire, if parsimony did not save and store up, the capital would never be the greater.