More than 10 years after the establishment of the six core competencies by the Accreditation Council for Graduate Medical Education, systems-based practice remains an elusive subject to teach, measure, and document. A wide variety of methods have been reported that address teaching and assessing performance for the discrete parts of systems-based practice; however, no single approach has been described that encompasses the competency in its entirety. To better understand the current state of this competency, orthopaedic residents and educators from around the country were surveyed to determine which systems-based practice topics were being taught at their institutions, how these topics were being taught, and how resident performance was assessed. Seven focus group sessions were held with members involved in the care of musculoskeletal patients to determine what they believed were essential skills for residents to learn relative to the healthcare system. Using this information, a health systems rotation was created for first-year residents that incorporated several different teaching and assessment methods. This rotation has received positive feedback from residents, patients, and health professionals. Its effect on resident development will be tracked over the next 5 years.