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From 1998 to 2015, Tufts Health Care Institute (THCI) offered a Mini-Rotation on the Health Care System, an intensive seminar for senior and chief residents, focusing on contemporary issues related to the organization and financing of the U.S. health care system as well as cost, quality, and access to care for patients and populations. In keeping with THCI’s mission, the course aimed to help senior and chief residents to practice more comfortably and effectively in a high-quality, cost-effective, patient-centered health care system. Residents who attended the THCI Mini-Rotation—and their preceptors—consistently expressed their enthusiasm and appreciation for the value of this experience. For residency program directors, the course addressed topics in the ACGME competency of Systems-based Practice and, to some extent, Practice-based Learning and Improvement.

We are now pleased to offer the Mini-Rotation materials to all interested faculty and administrators at teaching hospitals and medical schools.

The four themes of the full seminar were:

  1. Organization and Financing of the U.S. Health Care System
  2. Quality Matters
  3. Cost, Access, Care Management & New Models of Care
  4. Health Reform & Shaping the Future

We encourage program directors and other faculty members to create similar learning opportunities for their residents and students, using the THCI model and our teaching materials as they fit your needs. In the following pages we describe our program and offer tips from our experience; and we provide instructional materials developed by THCI staff and presenters to use and share in addressing these topics.


The annual THCI Mini-Rotation was structured as a dedicated program held on consecutive days for selected senior and chief residents. Expert faculty were drawn primarily from physician leaders in New England health plans, delivery systems, and institutions, and related stakeholder organizations.

The goal of this course was to help senior and chief residents to practice more comfortably and effectively in a complex and evolving health care environment. The program helped participants gain knowledge and insight into topics related primarily to the competency of Systems-based Practice, including:

  • Health care organization and financing
  • Public and private insurance
  • Pay-for-performance incentives
  • Drivers of health care costs
  • Quality assessment
  • Chronic care management
  • New models of care
  • Health care reform initiatives

Over the years, THCI received small grants to cover direct expenses (food and course materials) for the course from the Tufts Health Plan Foundation and from pharmaceutical companies. This support allowed us to invite attendees at no charge. Course faculty, drawn from local organizations, contributed their time and expertise without remuneration.

While THCI ran the course on 4-5 consecutive days with a total of twenty or more sessions, you may wish to organize individual sessions spread over a longer period of time, depending on your needs and available faculty.


THCI’s Residency Rotation was featured in these publications: