Rationale and Objectives
To better prepare radiology residents for providing care within the context of the larger health care system, this study evaluated the feasibility and impact of a curriculum to enhance radiology residents’ understanding and ability to apply concepts from medical management and industrial and operational engineering to systems-based practice problems in radiology practice.
Materials and Methods
A multiprofessional team including radiology, medical education, and industrial and operational engineering professionals collaborated in developing a seven-module curriculum, including didactic lectures, interactive large-group analysis, and small-group discussions with case-based radiology examples, which illustrated real-life management issues and the roles physicians held. Residents and faculty participated in topic selection. Pre- and post-instruction formative assessments were administered, and results were shared with residents during teaching sessions.
Results
Attendance and participation in case-based scenario resolutions indicate the feasibility and impact of the interactive curriculum on residents’ interest and ability to apply curricular concepts to systems-based practice in radiology. Paired t test analyses ( P < .05) and effect sizes showed residents significantly increased their knowledge and ability to apply concepts to systems-based practice issues in radiology.
Conclusions
Our iterative curriculum development and implementation process demonstrated need and support for a multiprofessional team approach to teach management and operational engineering concepts. Curriculum topics are congruent with Accreditation Council for Graduate Medical Education requirements for systems-based practice. The case-based curriculum using a mixed educational format of didactic lectures and small-group discussion and problem analysis could be adopted for other radiology programs, for both residents and continuing medical education applications.
To increase residents’ understanding of health care systems so that physicians can initiate and lead improvements in health care delivery, the Accreditation Council for Graduate Medical Education (ACGME) introduced a mandate that residency programs provide training and assessment of resident competency in “systems-based practice” (SBP). As Graham et al caution, the ACGME provides a broad definition of SBP—“an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value”—but does not provide operational definitions or scope of practice for specific medical specialties .
Medical educators have stressed the value of formal resident training in SBP, drawing on principles and strategies from health care policy, management, and business to lead health care improvements . However, few residents have formal training in business or management principles before or during residency . Consequently, when faced with complex business and management decisions in health systems, they are unsure how to proceed, frame questions, and seek assistance.
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Materials and methods
Subjects
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Topic Selection
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Table 1
Description of Modules and Number of Residents Completing Module
Module # Module Title Module Description No. of Residents ∗ Pilot Costing Analysis Lack of financial metrics for management decision making and how to create them with costing analysis 19 1 Fundamentals of Improvement: The Quality Gap Methods and tools for quality management:
Plan-Do-Study-Act (PDSA) and lean process improvement approaches 20 2 Profiles of Practice Groups and Compensation Current radiology practice group sizes and patterns of hiring
Compensation: starting and partnership levels
Range of workloads and structures of practice 18 3 Group Governance and Merger: How to Select, Govern, and Thrive in Group Practice Organizational dynamics and governance issues presented as the culture of the corporation
How to recognize and adapt group culture in a competitive business environment 14 4 Data Collection: Partnering with Engineers: Techniques for Process Improvement in MR Examples from ongoing work with the Industrial and Operations Engineering Department
How to derive and communicate actionable data for process and quality improvement by gathering workplace observations 16 5 Fixing Health Care: Harvard Business Review April 2010 Issue Health care policy and economics through the business lens
National and worldwide data on the health care economics and business models 11 6 Negotiation and Conflict Management Negotiation and leadership strategies
Conflict management techniques applied to radiology examples 7
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Curriculum Development
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Table 2
Description of Module Topics and Associated Systems-Based Practice Resident Role
∗ Adapted with permission from Graham MJ, Naqvi Z, Encandela J, et al. Systems-based practice defined: taxonomy development and role identification for competency assessment of residents. J Grad Med Educ 2009; September:49–60.
Module # Title Systems-Based Practice (SBP) Resident Roles Pilot Costing Analysis Resource manager
System evaluator 1 Fundamentals of Improvement: The Quality Gap System evaluator
Patient advocate
Resource manager
Care coordinator 2 Profiles of Practice Groups and Compensation System consultant
Team collaborator 3 Group Governance and Merger: How to Select, Govern and Thrive in Group Practice System evaluator
Team collaborator 4 Data Collection: Partnering with Engineers: Techniques for Process Improvement in MR Resource manager
Care coordinator 5 Fixing Health Care: Harvard Business Review April 2010 Issue. System consultant
Resource manager
Team collaborator
Patient advocate 6 Negotiation and Conflict Management. Patient advocate
Team collaborator
System consultant
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Educational Intervention
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Assessment
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Statistical Analysis
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Results
Curriculum Feasibility
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Assessment of Knowledge and Confidence
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Discussion
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Acknowledgments
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