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Porat-Dahlerbruch J, Aiken LH, Todd B, Cunningham R, Brom H, Peele ME, McHugh MD. Policy Evaluation Of The Affordable Care Act Graduate Nurse Education Demonstration. Health Aff (Millwood) 2022; 41:86-95. [PMID: 34982635 PMCID: PMC9022679 DOI: 10.1377/hlthaff.2021.01328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The US is experiencing a shortage of primary care providers, which could be reduced by the addition of nurse practitioners. However, the ability to increase the supply of nurse practitioners is limited by a shortage of clinical preceptors. The Affordable Care Act's Graduate Nurse Education Demonstration provided federal funding to offset the clinical training costs of advanced practice nurses. We used data from the American Association of Colleges of Nursing from academic years 2005-06 through 2017-18 to determine whether the demonstration was associated with increased nurse practitioner enrollment and graduation growth. The demonstration was associated with a significant increase in nurse practitioner enrollments and graduations. A promising model of organizing and implementing funding for graduate nursing education nationally was identified. Findings suggest that modernizing Medicare payments for nursing education to support nurse practitioner clinical training costs is a promising option for increasing primary care providers.
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Affiliation(s)
| | | | - Barbara Todd
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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2
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Shahlaie K, Harsh GR. Editorial. The financial value of a neurosurgery resident. J Neurosurg 2020; 135:164-168. [PMID: 32916648 DOI: 10.3171/2020.4.jns20836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Gupta R, Sehgal N, Arora VM. Aligning Delivery System and Training Missions in Academic Medical Centers to Promote High-Value Care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1289-1292. [PMID: 31460917 DOI: 10.1097/acm.0000000000002573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Academic medical centers (AMCs) are transforming to improve their care delivery and learning environments so that they build a culture that fosters high-value care. However, AMCs struggle to create learning environments where trainees are part of the reason for institutional success and their initiatives have high impact and are sustainable. The authors believe that AMCs can reach these goals if they codevelop strategic priorities and provide infrastructure to support alignment between the missions of health delivery systems and graduate medical education (GME).They outline four steps for AMCs and policy makers to create an infrastructure that supports this alignment to deliver value-based care. First, AMCs can align strategic priorities between delivery systems and educators by creating a common understanding of why initiatives require priorities within the health care system. Second, AMCs can support alignment with data from multiple sources that are reliable, valid, and actionable for trainees. Third, resident initiatives can create sustained impact by linking trainees to the institutional staff and infrastructure supporting value improvement efforts. Fourth, incentive payment programs through medical education could augment current system incentives to propel further alignment between education and delivery systems. The authors support their recommendations with concrete examples from emerging models created by GME and health delivery system leaders at AMCs across the country.
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Affiliation(s)
- Reshma Gupta
- R. Gupta is medical director for quality and value improvement, UCLA Health, assistant professor, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, California, and director of evaluation and outreach, Teaching Value in Healthcare Learning Network, Costs of Care, Boston, Massachusetts. N. Sehgal is professor, Department of Medicine, University of California, San Francisco, School of Medicine (UCSF), and vice president and chief quality officer, UCSF Health, San Francisco, California. V.M. Arora is professor, Department of Medicine, and director of GME clinical learning environment innovation, University of Chicago Pritzker School of Medicine, Chicago, Illinois, and director of educational initiatives, Costs of Care, Boston, Massachusetts
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Tackett S. Examining the Educational Commission for Foreign Medical Graduates Announcement Requiring Medical School Accreditation Beginning in 2023. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:943-949. [PMID: 30844935 DOI: 10.1097/acm.0000000000002675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In 2010, the Educational Commission for Foreign Medical Graduates (ECFMG, Philadelphia, Pennsylvania) announced that, beginning in 2023, graduation from a formally accredited medical school would be necessary for an international medical graduate (IMG) to be eligible for ECFMG certification. The announcement is notable because ECFMG certification is required for graduate medical training and practice in the United States. Graduating from a school accredited by an agency formally recognized by the World Federation for Medical Education (WFME), which has been formally evaluating and recognizing accrediting agencies since 2012, would fulfill the new ECFMG requirement. In 2015, ECFMG applicants came from 1,141 medical schools located in 139 countries or territories. As of December 2018, the WFME had formally recognized 14 accrediting agencies, which would cover only approximately a third of these recent ECFMG-certified IMGs. In this Perspective, the author compares the context of the ECFMG announcement to the beginning of accreditation in the United States so as to provide insight into the challenges the WFME faces as it seeks to evaluate and recognize what could ultimately be over 100 more accrediting authorities. The author then explores the possible effects of the requirement-specifically, its potential to restrict the ECFMG applicant pool-on the quantity and quality of the U.S. physician workforce. The author ends the Perspective by considering the implications of three broad policy options that the ECFMG could consider starting in 2023: implementation as announced, maintenance of the status quo, or a policy modified from the original announcement.
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Affiliation(s)
- Sean Tackett
- S. Tackett is assistant professor of medicine and director, International Medical Education, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; ORCID: https://orcid.org/0000-0001-5369-7225
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Smirnova A, Sebok-Syer SS, Chahine S, Kalet AL, Tamblyn R, Lombarts KMJMH, van der Vleuten CPM, Schumacher DJ. Defining and Adopting Clinical Performance Measures in Graduate Medical Education: Where Are We Now and Where Are We Going? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:671-677. [PMID: 30720528 DOI: 10.1097/acm.0000000000002620] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Assessment and evaluation of trainees' clinical performance measures is needed to ensure safe, high-quality patient care. These measures also aid in the development of reflective, high-performing clinicians and hold graduate medical education (GME) accountable to the public. Although clinical performance measures hold great potential, challenges of defining, extracting, and measuring clinical performance in this way hinder their use for educational and quality improvement purposes. This article provides a way forward by identifying and articulating how clinical performance measures can be used to enhance GME by linking educational objectives with relevant clinical outcomes. The authors explore four key challenges: defining as well as measuring clinical performance measures, using electronic health record and clinical registry data to capture clinical performance, and bridging silos of medical education and health care quality improvement. The authors also propose solutions to showcase the value of clinical performance measures and conclude with a research and implementation agenda. Developing a common taxonomy of uniform specialty-specific clinical performance measures, linking these measures to large-scale GME databases, and applying both quantitative and qualitative methods to create a rich understanding of how GME affects quality of care and patient outcomes is important, the authors argue. The focus of this article is primarily GME, yet similar challenges and solutions will be applicable to other areas of medical and health professions education as well.
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Affiliation(s)
- Alina Smirnova
- A. Smirnova is a PhD researcher, School of Health Professions Education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands, and Professional Performance Research Group, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. S.S. Sebok-Syer is instructor, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California. S. Chahine is assistant professor and scientist, Centre for Educational Research and Innovation (CERI), Western University, London, Ontario, Canada. A.L. Kalet is professor of medicine and surgery, director of research on medical education outcomes (ROMEO), Unit of the Division of General Internal Medicine and Clinical Innovation, Department of Medicine, and director of research, Program on Medical Education and Technology, NYU School of Medicine, New York, New York. R. Tamblyn is professor, Department of Medicine and Department of Epidemiology and Biostatistics, McGill University, medical scientist, McGill University Health Center Research Institute, scientific director, Clinical and Health Informatics Research Group, McGill University, and scientific director, Canadian Institutes of Health Research-Institute of Health Services and Policy Research, Montreal, Quebec, Canada. K.M.J.M.H. Lombarts is professor and lead investigator, Professional Performance Research Group, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. C.P.M. van der Vleuten is professor and scientific director, School of Health Professions Education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. D.J. Schumacher is associate professor, Division of Emergency Medicine, and pediatric emergency physician, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio
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Rao AR, Clarke D. Exploring relationships between medical college rankings and performance with big data. BIG DATA ANALYTICS 2019. [DOI: 10.1186/s41044-019-0040-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Value of Global Surgical Activities for US Academic Health Centers: A Position Paper by the Association for Academic Surgery Global Affairs Committee, Society of University Surgeons Committee on Global Academic Surgery, and American College of Surgeons' Operation Giving Back. J Am Coll Surg 2018; 227:455-466.e6. [DOI: 10.1016/j.jamcollsurg.2018.07.661] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/11/2018] [Indexed: 11/17/2022]
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Aiken LH, Dahlerbruch J, Todd B, Bai G. The Graduate Nurse Education Demonstration - Implications for Medicare Policy. N Engl J Med 2018; 378:2360-2363. [PMID: 29924953 PMCID: PMC7179088 DOI: 10.1056/nejmp1800567] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Linda H Aiken
- From the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing (L.H.A., J.D., B.T.), the Leonard Davis Institute for Health Economics, University of Pennsylvania (L.H.A.), and the Hospital of the University of Pennsylvania (B.T.) - both in Philadelphia; and the Johns Hopkins Carey Business School, Baltimore (G.B.)
| | - Joshua Dahlerbruch
- From the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing (L.H.A., J.D., B.T.), the Leonard Davis Institute for Health Economics, University of Pennsylvania (L.H.A.), and the Hospital of the University of Pennsylvania (B.T.) - both in Philadelphia; and the Johns Hopkins Carey Business School, Baltimore (G.B.)
| | - Barbara Todd
- From the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing (L.H.A., J.D., B.T.), the Leonard Davis Institute for Health Economics, University of Pennsylvania (L.H.A.), and the Hospital of the University of Pennsylvania (B.T.) - both in Philadelphia; and the Johns Hopkins Carey Business School, Baltimore (G.B.)
| | - Ge Bai
- From the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing (L.H.A., J.D., B.T.), the Leonard Davis Institute for Health Economics, University of Pennsylvania (L.H.A.), and the Hospital of the University of Pennsylvania (B.T.) - both in Philadelphia; and the Johns Hopkins Carey Business School, Baltimore (G.B.)
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Schickedanz A, Gupta R, Arora VM, Braddock CH. Measuring Value in Internal Medicine Residency Training Hospitals Using Publicly Reported Measures. Am J Med Qual 2018; 33:604-613. [PMID: 29637791 PMCID: PMC6697657 DOI: 10.1177/1062860618767312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Graduate medical education (GME) lacks measures of resident preparation for high-quality, cost-conscious practice. The authors used publicly reported teaching hospital value measures to compare internal medicine residency programs on high-value care training and to validate these measures against program director perceptions of value. Program-level value training scores were constructed using Centers for Medicare & Medicaid Services Value-Based Purchasing (VBP) Program hospital quality and cost-efficiency data. Correlations with Association of Program Directors in Internal Medicine Annual Survey high-value care training measures were examined using logistic regression. For every point increase in program-level VBP score, residency directors were more likely to agree that GME programs have a responsibility to contain health care costs (adjusted odds ratio [aOR] 1.18, P = .04), their faculty model high-value care (aOR 1.07, P = .03), and residents are prepared to make high-value medical decisions (aOR 1.07, P = .09). Publicly reported clinical data offer valid measures of GME value training.
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Affiliation(s)
- Adam Schickedanz
- Primary Care & Health Services Research Fellow, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA
| | - Reshma Gupta
- Medical Director for Quality Improvement & Value at UCLA Health, Department of Medicine, University of California Los Angeles, Los Angeles, CA
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Jackson JB, Vincent S, Davies J, Phelps K, Cornett C, Grabowski G, Scannell B, Stotts A, Bice M. A Prospective Multicenter Evaluation of the Value of the On-Call Orthopedic Resident. J Grad Med Educ 2018; 10:91-94. [PMID: 29467980 PMCID: PMC5821009 DOI: 10.4300/jgme-d-17-00277.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/31/2017] [Accepted: 09/17/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Funding for graduate medical education is at risk despite the services provided by residents. OBJECTIVE We quantified the potential monetary value of services provided by on-call orthopedic surgery residents. METHODS We conducted a prospective, cross-sectional, multicenter cohort study design. Over a 90-day period in 2014, we collected data on consults by on-call orthopedic surgery residents at 4 tertiary academic medical centers in the United States. All inpatient and emergency department consults evaluated by first-call residents during the study period were eligible for inclusion. Based on their current procedural terminology codes, procedures and evaluations for each consult were assigned a relative value unit and converted into a monetary value to determine the value of services provided by residents. The primary outcome measures were the total dollar value of each consult and the percentage of resident salaries that could be funded by the generated value of the resident consult services. RESULTS In total, 2644 consults seen by 33 residents from the 4 institutions were included for analysis. These yielded an average value of $81,868 per center for the 90-day study period, that is, $327,471 annually. With a median resident stipend of $53,992, the extrapolated average percentage of resident stipends that could be funded by these consult revenues was 73% of the stipends of the residents who took call or 36% of the stipends of the overall resident cohort. CONCLUSIONS The potential monetary value generated by on-call orthopedic surgery residents is substantial.
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Hoelle RM, Vega T, Atanelov Z, Toklu H. Emergency medicine residency programs: the changing face of graduate medical education. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2018; 9:9-10. [PMID: 29341955 PMCID: PMC5834821 DOI: 10.5116/ijme.5a47.8274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/30/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Robyn M. Hoelle
- University of Central Florida/HCA GME Consortium North Florida Medical Center, Gainesville, USA
| | - Tami Vega
- University of Central Florida/HCA GME Consortium North Florida Medical Center, Gainesville, USA
| | - Zaza Atanelov
- University of Central Florida/HCA GME Consortium North Florida Medical Center, Gainesville, USA
| | - Hale Toklu
- University of Central Florida/HCA GME Consortium North Florida Medical Center, Gainesville, USA
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12
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Discussion: State of the Plastic Surgery Workforce and the Impact of Graduate Medical Education Reform on Training of Plastic Surgeons. Plast Reconstr Surg 2017; 140:421-423. [PMID: 28746292 DOI: 10.1097/prs.0000000000003513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Nousiainen M, Incoll I, Peabody T, Marsh JL. Can We Agree on Expectations and Assessments of Graduating Residents?: 2016 AOA Critical Issues Symposium. J Bone Joint Surg Am 2017; 99:e56. [PMID: 28590386 DOI: 10.2106/jbjs.16.01048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Orthopaedic educators are responsible for training a prepared and competent workforce that will provide effective care for a growing number of patients with musculoskeletal conditions. Currently, there are both internal and external forces that pose substantial challenges to medical students, residents, program directors, faculty members, and chairs in achieving this goal. One area of particular concern is the education of surgeons, whose knowledge and professional behavior must be matched by their ability to acquire procedural skills. In order to address this issue, many training systems have implemented a competency-based training approach into their curricula. This article discusses the efforts that orthopaedic training bodies in Canada and Australia have taken toward competency-based education and what steps the American Board of Orthopaedic Surgery (ABOS), the Council of Orthopaedic Residency Directors (CORD), the American Orthopaedic Association (AOA), the American Academy of Orthopaedic Surgeons (AAOS), and the Accreditation Council for Graduate Medical Education (ACGME) are considering to improve residency education in the current and future environments.
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Affiliation(s)
- Markuu Nousiainen
- 1University of Toronto, Toronto, Ontario, Canada 2Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia 3Northwestern University, Chicago, Illinois 4University of Iowa, Iowa City, Iowa
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Lieff SJ, Yammarino FJ. How to Lead the Way Through Complexity, Constraint, and Uncertainty in Academic Health Science Centers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:614-621. [PMID: 28441672 DOI: 10.1097/acm.0000000000001475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Academic medicine is in an era of unprecedented and constant change due to fluctuating economies, globalization, emerging technologies, research, and professional and educational mandates. Consequently, academic health science centers (AHSCs) are facing new levels of complexity, constraint, and uncertainty. Currently, AHSC leaders work with competing academic and health service demands and are required to work with and are accountable to a diversity of stakeholders. Given the new challenges and emerging needs, the authors believe the leadership methods and approaches AHSCs have used in the past that led to successes will be insufficient. In this Article, the authors propose that AHSCs will require a unique combination of old and new leadership approaches specifically oriented to the unique complexity of the AHSC context. They initially describe the designer (or hierarchical) and heroic (military and transformational) approaches to leadership and how they have been applied in AHSCs. While these well-researched and traditional approaches have their strengths in certain contexts, the leadership field has recognized that they can also limit leaders' abilities to enable their organizations to be engaged, adaptable, and responsive. Consequently, some new approaches have emerged that are taking hold in academic work and professional practice. The authors highlight and explore some of these new approaches-the authentic, self, shared, and network approaches to leadership-with attention to their application in and utility for the AHSC context.
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Affiliation(s)
- Susan J Lieff
- S.J. Lieff is director of academic leadership development, Centre for Faculty Development, University of Toronto Faculty of Medicine and St. Michael's Hospital, and professor and vice chair of education, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.F.J. Yammarino is director, Centre for Leadership Studies, and SUNY Distinguished Professor of Management, School of Management, Binghamton University, Binghamton, New York
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Van Dermark JT, Wald DA, Corker JR, Reid DG. Financial Implications of the Emergency Medicine Interview Process. AEM EDUCATION AND TRAINING 2017; 1:60-69. [PMID: 30051011 PMCID: PMC6001822 DOI: 10.1002/aet2.10011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/22/2016] [Accepted: 11/08/2016] [Indexed: 05/30/2023]
Abstract
BACKGROUND Emergency medicine (EM) residency interviews are an important, yet costly process for programs and applicants. The total economic burden of the EM interviewing process is previously unstudied. Graduate medical education funding and student finances are both fragile shifting sources, which appear to fund most of these economic expenditures. OBJECTIVES The total economic impact of the EM interview season is unknown. This study sought to calculate total dollars spent by EM residency programs and senior medical students (M4) during interview season. Potential solutions for reducing this burden will be outlined. METHODS Institutional review board-approved, piloted e-mail surveys were sent to accredited (Accreditation Council for Graduate Medical Education [ACGME] and American Osteopathic Association [AOA]) EM program directors (PDs) and M4 student members of EMRA. PDs were queried after the 2014-2015 interview season. PDs questions included demographics, estimated faculty, and resident and administrative time used, along with dollars spent during the 2014-2015 interview season. M4 questions included demographics and dollars spent during the 2015-2016 season. Results were reported using descriptive statistics. Financial data for EM programs were calculated with academic EM faculty, resident, and administrative assistant salaries along with reported hours used during the interview season. RESULTS A total of 82 of 223 EM PDs completed the survey, reporting an mean annual cost of $210,649.04 per program to review, screen, and interview applicants based on time spent by faculty, resident, and administrative assistants. A total of 84.6% of EM program costs were due to faculty hours. A total of 180 of 1,425 EM-bound M4 students completed the survey, reporting a mean annual estimate of US$5,065.44 per student to apply and interview. Seventy-two percent of estimated costs were due to airfare and lodging. Loans and credit cards were the top two methods of payments of these interview costs by students. Extrapolating the cost of EM personnel with hours spent, the economic burden of an interview season for EM programs is approximately US$46,974,735.92. M4 students spent US$19,724,823.40 for application fees and interview-related expenses. CONCLUSIONS Emergency medicine residency programs and applicants appear to spend over US$66 million per cycle on the interview process. EM residency programs may save resources by reducing faculty hours associated with the interview process and leveraging administrative and resident resources. Creation of regional or national fixed interview locations may also be appropriate. Applicants may reduce travel costs by participating in video interviews, reducing program applications, and attending regionalized interview days. A full conversation among all specialties and organized medicine needs to take place to reform the systems in place to reduce the economic burden on students and residency programs.
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Affiliation(s)
| | - David A. Wald
- Department of Emergency MedicineLewis Katz School of Medicine, Temple UniversityPhiladelphiaPA
| | - John Robert Corker
- Department of Emergency MedicineUniversity of Texas Southwestern Medical Center/Parkland Healthcare SystemDallasTX
| | - David Godley Reid
- Department of Emergency MedicineUniversity of Texas Southwestern Medical Center/Parkland Healthcare SystemDallasTX
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DeWitt D, Canny BJ, Nitzberg M, Choudri J, Porter S. Medical student satisfaction, coping and burnout in direct-entry versus graduate-entry programmes. MEDICAL EDUCATION 2016; 50:637-645. [PMID: 27170082 DOI: 10.1111/medu.12971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/21/2015] [Accepted: 11/13/2015] [Indexed: 06/05/2023]
Abstract
CONTEXT There is ongoing debate regarding the optimal length of medical training, with concern about the cost of prolonged training. Two simultaneous tracks currently exist in Australia: direct entry from high school and graduate entry for students with a bachelor degree. Medical schools are switching to graduate entry based on maturity, academic preparedness and career-choice surety. We tested the assumption that graduate entry is better by exploring student preferences, coping, burnout, empathy and alcohol use. METHODS From a potential pool of 2188 participants, enrolled at five Australian medical schools, a convenience sample of 688 (31%) first and second year students completed a survey in the middle of the academic year. Participants answered questions about demographics, satisfaction and coping and completed three validated instruments. RESULTS Over 90% of students preferred their own entry-type, though more graduate-entry students were satisfied with their programme (82.4% versus 65.3%, p < 0.001). There was no difference between graduate-entry and direct-entry students in self-reported coping or in the proportion of students meeting criteria for burnout (50.7% versus 51.2%). Direct-entry students rated significantly higher for empathy (concern, p = 0.022; personal distress, p = 0.031). Graduate-entry students reported significantly more alcohol use and hazardous drinking (30.0% versus 22.8%; p = 0.017). CONCLUSIONS Our multi-institution data confirm that students are generally satisfied with their choice of entry pathway and do not confirm significant psychosocial benefits of graduate entry. Overall, our data suggest that direct-entry students cope with the workload and psychosocial challenges of medical school, in the first 2 years, as well as graduate-entry students. Burnout and alcohol use should be addressed in both pathways. Despite studies showing similar academic outcomes, and higher total costs, more programmes in Australia are becoming graduate entry. Further research on non-cognitive issues and outcomes is needed so that universities, government funders and the medical profession can decide whether graduate entry, direct entry, or a mix, is ideal.
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Affiliation(s)
- Dawn DeWitt
- Rural Health Academic Centre, Melbourne Medical School, Shepparton, Victoria, Australia
| | - Benedict J Canny
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael Nitzberg
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, US
| | - Jennifer Choudri
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, US
| | - Sarah Porter
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, US
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Stoller J, Pratt S, Stanek S, Zelenock G, Nazzal M. Financial Contribution of Residents When Billing as "Junior Associates" in the "Surgical Firm". JOURNAL OF SURGICAL EDUCATION 2016; 73:85-94. [PMID: 26684417 DOI: 10.1016/j.jsurg.2015.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/26/2015] [Accepted: 06/18/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE There is an increasing number of proposals to change the way Graduate Medical Education is funded. This study attempts to estimate the potential financial contribution of surgical residents using an alternative funding mechanism similar to that used by law firms, which would allow surgery departments to bill for resident activity as "junior associates." METHODS Following 24 residents over a period of 12 weeks, we were able to estimate the annual revenue that they generated from operating room procedures, independent consultations, patient management, and minor procedures using Medicare reimbursement rates. The appropriate first assistant modifier was used to calculate the operating room procedure fees, but full price was used to calculate the revenue for minor procedures, patient management, and consultations done independently. We adjusted for vacation time and academic activities. RESULTS Including postgraduate year 1 residents, the estimated yearly revenue generated per resident in first assistant operative services was $33,305.67. For minor procedures, patient management, and independent consultations, the estimated yearly revenue per resident was $37,350.66. The total estimated financial contribution per resident per year was $70,656.33. Excluding postgraduate year 1 residents, as most states require completion of the intern year before full licensure, the estimated yearly revenue generated per resident in first assistant operative services was $38,914.56. For minor procedures, patient management, and independent consultations, the estimated yearly revenue per resident was $55,957.33. The total estimated financial contribution per resident per year was $94,871.89. CONCLUSIONS Residents provide a significant service to hospitals. If resident activity was compensated at the level of supervised "junior associates" of a surgery department, more than 75% of the direct educational costs of training could be offset. Furthermore, we believe this value is underestimated. Given the foreseeable changes in Graduate Medical Education funding, it is imperative that alternative approaches for funding be explored.
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Affiliation(s)
- Jeremy Stoller
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Sarah Pratt
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Stephen Stanek
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Gerald Zelenock
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Munier Nazzal
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio.
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Chung BM. The State of Graduate Medical Education Funding and Meeting Our Nation's Health Care Needs. J Osteopath Med 2015. [PMID: 26214820 DOI: 10.7556/jaoa.2015.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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