Background: The Systems-Based Practice competency expanded the scope of graduate medical education. Innovative approaches are needed to teach this material. Purpose: We have designed and implemented a rotation in Systems-Based Practice focused on the interrelationships of patient care, clinical revenue, and the physician's role within health care systems. Methods: Experiential learning occurs during a 5-day rotation through 26 areas encompassing the clinical revenue cycle, guided by "expert" staff. Using a reversal of the TV show Survivor, house staff begin conceptually "alone" and discover they are members of a large, dedicated team. Assessment results, including a system knowledge test and course evaluations, are presented. Results: Twenty-five residents from four clinical departments participated in Year 1. An increase in pretest to posttest knowledge scores of 14.8% (p ≤ 0.001) was observed, with high program evaluations. Conclusions: "Systems Survivor" is successful in providing an innovative opportunity to explore complex health care systems and is an effective curriculum.
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