Rationale and Objectives
Since July 2013, the Accreditation Council for Graduate Medical Education (ACGME) has required radiology residency programs to implement a set of educational milestones to track residents’ educational advancement in six core competencies, including Systems-based Practice. The healthcare economics subcompetency of Systems-based Practice has traditionally been relatively neglected, and given the new increased ACGME oversight, will specifically require greater focused attention.
Materials and Methods
A multi-institutional health-care economics pilot curriculum combining didactic and practical components was implemented across five residency programs. The didactic portion included a package of online recorded presentations, reading, and testing materials developed by the American College of Radiology (ACR’s) Radiology Leadership Institute. The practical component involved a series of local meetings led by program faculty with the production of a deliverable based on research of local reimbursement for a noncontrast head computed tomography. The capstone entailed the presentation of each program’s deliverable during a live teleconference webcast with a Radiology Leadership Institute content expert acting as moderator and discussion leader.
Results
The pilot curriculum was well received by residents and faculty moderators, with 100% of survey respondents agreeing that the pilot met its objective of introducing how reimbursement works in American radiology in 2015 and how business terminology applies to their particular institutions.
Conclusion
A health-care economics curriculum in the style of a Massive Open Online Course has strong potential to serve as many residency programs’ method of choice in meeting the health-care economics milestones.
Introduction
Following the recent implementation of the Accreditation Council for Graduate Medical Education (ACGME) Milestones guidelines, our residency program, like many others, was prepared and confident in satisfying the clinically based milestone requirements. The only exception was the Healthcare Economics Milestones component of the Systems-based Practice competency. From anecdotal reports, organized discussions at the annual Association of University Radiologists meetings, and published literature, it became clear that this was a weak point in many radiology residency programs. In the past, authors have published their experiences with teaching this subject to radiology residents by utilizing unique, program-specific curricula . What they shared in common were faculty members who were well versed in the subject matter and had the institutional resources to support a custom, program-specific curriculum. We soon realized that although the radiology faculty at Tufts Medical Center (TMC) were enthusiastic about teaching health-care economics to our radiology residents, their relative lack of content experience and resources would hamper attempts at developing a unique curriculum that would efficiently fulfill the requirements of the healthcare economics milestones.
The challenges of teaching healthcare economics to radiology residents are manifold, including the complexity of managing and corralling the bounty of available business-oriented radiology literature and existing content into a streamlined learning experience. Underlying this issue is the hurdle of making the content accessible to finance-naive radiology residents. Indeed, residents have shown great interest in this subject matter despite residency programs largely maintaining their focus on teaching interpretive skills . As a result, we endeavored to devise a delivery technique that would not interfere with residents’ primary clinical responsibilities.
Materials and Methods
Get Radiology Tree app to read full this article<
Table 1
Adapted from The Diagnostic Radiology Milestone Project and the Association of Program Directors in Radiology
Milestone Definition Health-care EconomicsLevel 1 The resident demonstrates milestones expected of one who has had some education in diagnostic radiology. Describes the mechanisms for reimbursement, including types of payers.Level 2 The resident is advancing and demonstrating additional milestones. States relative cost of common procedures.Level 3 The resident continues to advance and demonstrate additional milestones; the resident consistently demonstrates the majority of milestones targeted for radiology. Describes the technical and professional components of imaging costs.Level 4 The resident has advanced so that he or she now substantially demonstrates the milestones targeted for residency. This level is designed as the graduation target. Describes measurements of productivity (e.g., RVUs).Level 5 The resident has advanced beyond performance targets set for residency and is demonstrating “aspirational” goals, which might describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional residents will reach this goal. Describes the radiology revenue cycle.
RVUs, Relative value units.
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Discussion
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Acknowledgment
Get Radiology Tree app to read full this article<
References
1. Chan S.: Management education during radiology residency: development of an educational practice. Acad Radiol 2004; 11: pp. 1308-1317.
2. Mirowitz S.A.: Development and assessment of a radiology core curriculum in health care policy and practice. Acad Radiol 2000; 7: pp. 540-550.
3. Otero H.J., Weissman B.N., Rybicki F.J.: System-based practice: proposal for a comprehensive curriculum. Acad Radiol 2008; 15: pp. 119-126.
4. Brandon C.J., Mullan P.B.: Teaching medical management and operations engineering for systems-based practice to radiology residents. Acad Radiol 2013; 20: pp. 345-350.
5. McArthur T.A., Prince E.L., Berland L.L., et. al.: Introduction to business for radiology senior residents. J Am Coll Radiol 2011; 8: pp. 205-208.
6. ACR : Radiology Leadership Institute—Residents & Fellows. Available at: http://www.radiologyleaders.org/resources/for-residents-and-fellows Accessed January 24, 2016
7. ACGME , ABR : The Diagnostic Radiology Milestone Project. Available at: https://www.acgme.org/acgmeweb/Portals/0/PDFs/Milestones/DiagnosticRadiologyMilestones.pdf Accessed January 24, 2016
8. Miller T., Resnik C.: Health care economics. Available at: http://apdr.org/template.aspx?id=1013 Accessed January 25, 2016
9. Prober A.S., Ledermann E., Norbash A., et. al.: Fulfilling the health care economics milestones: adopting an online curriculum for radiology residency programs. J Am Coll Radiol 2015; 12: pp. 314-317.
10. Williams S.M.: Putting case-based instruction into context: examples from legal and medical education. J Learn Sci 1992; 2: pp. 367-427.
11. Harvard Business School : The case method at HBS. Available at: http://www.hbs.edu/teaching/inside-hbs/ Accessed January 24, 2016