Business of Radiology 101: The State of Radiology Business Practice & Healthcare Policy Curricula at US Radiology Residency Programs
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Tang J, Dicks DL, Kohr JR, Stratil PG, Cinelli CM, Monroe EJ, Medverd JR
The University of Washington Department of Radiology, Seattle, Washington.
Background
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Results Continued
The United States (US) has been experiencing a period of rapid changes in healthcare delivery and financing. It has been asserted that the future career success, as well as job
satisfaction, of today’s radiology resident hinges as much upon developing excellence in the performance and interpretation of radiological examinations as acquiring awareness of the
larger context and system of health care and the ability to effectively call upon system resources to provide care of optimal value [1]. Despite the importance of these non-interpretive
skills, radiologists have generally not been trained in basic business principles and regulatory trends while in residency.
Several individual residency curriculum proposals have been published over the past decade which include suggestions for a thorough curriculum in business and policy principles [1-4].
Furthermore, organizations such as the Association of Program Directors in Radiology (APDR), the Radiological Society of North America (RSNA), and the American College of Radiology
(ACR) have supported initiatives to assist programs with these educational requirements. Despite these steps, effectively incorporating the wide array of topics included in non-interpretive
curricula into a residency can be difficult and it is unclear to what extent all US residency programs have addressed these requirements or what methods are being used.
Perceived Importance of Non-interpretive Curriculum
Responses to the questions “do you feel developing an understanding and element of command of radiology business topics [and] healthcare policy topics and their impact on
radiology practices will be important to resident future careers?” indicate program director and resident groups agree that a non-interpretive curriculum is important to the
future careers of residents.
APDR
RFS Delegates
60%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
50%
40%
30%
Purpose
20%
10%
To assess the prevalence, content and perceived effectiveness of curricula focused on radiology business practice and healthcare policy at US radiology residencies.
0%
Strongly
disagree
Methods
Three surveys were distributed. An online survey was sent to the membership of the APDR by email in June 2010. A similar paper survey was distributed to ACR Resident &
Fellow Section (RFS) representatives attending the ACR Annual Meeting & Chapter Leadership Conference (AMCLC) May 2010 (“RFS Delegates”). An abbreviated online
survey was sent to the entire ACR RFS membership by email in December 2009 with a second request in April 2010 (“RFS Members”). These questions were included as
subsection of a larger survey exploring quality issues in residency training performed as a function of an ACR Quality Fellowship experience by two of our authors (CMC,
JRK).
Email surveys were anonymous and collected over several weeks. However, the majority of responses were logged close to the date of invitation. Paper surveys were
anonymously collected on the same day as distributed.
Disagree
+/-
Agree
Strongly agree
Not at all
Minimally
Moderately
RFS Delegates
RFS Members
57%
Quality
71%
64%
56%
Bus Pract
Medical and business ethics
67%
39%
52%
HC Policy
Radiology Informatics
67%
44%
42%
Contracts, negotiation
60%
44%
40%
Medical billing and reimbursement
57%
53%
47%
Evidence - based radiology
52%
39%
56%
Leadership, communication skills
50%
28%
31%
Health care policy
47%
53%
54%
Personal finance
31%
33%
41%
Performance metrics
24%
25%
17%
Practice governance, organizational models
19%
14%
23%
Accounting principles/financial statements
16%
22%
18%
Strategic planning
12%
11%
16%
Other topic(s) (please specify)
7%
0%
0%
Discussion
0%
No response
1 - 4 hr
5 - 8 hr
9 - 12 hr
> 12 hr
Educational Modalities
Modalities used most often included didactic lectures (96%), journal clubs (42%), small group activities (21%), discussion panels (10%), and online materials (<10%).
80%
APDR
RFS Delegates
RFS Members
Sm
Disc
Jrnl
Group
Panel
Club
On-line
Other
Perceived Efficacy of Non-interpretive Curriculum
APDR and both RFS groups were asked to rate the effectiveness of non-interpretive curricula in use at their institutions. Respondents most often rated curricula as
“moderately” effective (45%, 58% respectively), followed by “marginally” or “minimally” effective (31%, 25%). Both groups infrequently rated their curricula as “very” effective
(12%, 6%).
APDR survey responses suggest that many curricula in use at radiology residency programs today do not provide a thorough overview of topics germane to radiology
business practice and healthcare policy. Topics of medicolegal, quality, medical & business ethics, radiology informatics, contracts & negotiation, medical billing &
reimbursement, and evidence-based radiology were widely addressed (>50% responding programs reporting inclusion). However, instruction in the soft skills of leadership &
communication, health care policy, practice governance & organizational models, and strategic planning, as well as the hard skills of accounting principles, performance
metrics and personal finance may currently be underemphasized (<50% responding programs reporting inclusion). Our survey instruments, designed for brevity, unfortunately
do not provide insight into the underlying cause. Future curricular efforts, if envisioned to be comprehensive, must provide exposure to the above identified underrepresented,
yet equally important, topics.
Residency training requirements in competencies related to radiology business practice and healthcare policy have been in place for over a decade. These survey data
provide insight into the level of adoption and content of curricular efforts currently in place within US radiology residency programs, and suggest that there is room for
improvement. Further commitment to and innovation within these curricula are needed.
References
RFS
50%
Other
Program directors and residents value radiology business practice and healthcare policy education, but our data on perceived effectiveness of individual program educational
efforts suggest that current curricula, while providing some value, are suboptimal when not absent. Barriers to excellence in the delivery of these curricula include a current
lack of consensus on curriculum, evolving best practices for curricula delivery, and absence of established outcomes measurement methodologies. Identification of time to
address non-interpretive curricular goals within the competing constraints of modern radiology residency programs is also a significant challenge.
100%
40%
30%
20%
10%
0%
Not effective
www.PosterPresentations.com
56%
10%
APDR
Prevalence of Non-interpretive Curriculum
Program director (APDR) responses to the question “does your residency have a curriculum addressing non – interpretive topics? “ suggest that 91% of US radiology
residencies include elements of these curricula at their programs.
TEMPLATE DESIGN © 2008
74%
0%
APDR
West
Medical - legal issues
20%
20%
ACGME
Midwest
RFS Member
30%
Lecture
South
RFS Del
40%
40%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Northeast
APDR
Very
60%
Geographic Representation
Distribution of responses generally mirrored the national balance of ACGME accredited US radiology residency programs.
Topic
Time Allocation for Non-interpretive Curriculum
Results from APDR survey respondents. Only 25% of residency programs allot >12 hours and 44% of programs spend 8 hours or less per academic year on curricula.
Results
Distribution & Response Rates
Attendance lists indicate that 210 RFS delegates registered for the 2010 ACR AMCLC. 150 paper surveys were distributed to delegates present at sessions when surveys
were solicited. At time of invitation, membership email roster lists were APDR 315, ACR RFS 3,530. Survey response rates were APDR 20% (64/315), RFS Delegates 37%
(56/150), and RFS Members 12% (439/3,580).
Non-interpretive Curriculum Topics
Topics most often reported as included in non-interpretive curricula are summarized below. Additional topics reported under the heading “Other” included physician fatigue,
physician impairment, disclosure policies & practice, publication & article review, statistical and critical literature review, patient safety ethics, and military related discussions.
Topics receiving at least 50% prevalence within any survey are highlighted in yellow.
Marginal
Moderate
Very
Unsure
70%
60%
50%
40%
30%
20%
10%
0%
Not at all
Minimal
Moderate
Very
1.
Otero HJ, Weissman BN, Rybicki FJ. System-based practice: proposal for a comprehensive curriculum. Acad Radiol 2008; 15:119-126.
RFS Delegates
2.
Chan S. Management Education During Radiology Residency: Development of an Educational Practice. Acad Radiol 2004; 11:1308-1317.
RFS Members
3.
Collins J, Rosado de Christenson M, et al. General Competencies in Radiology Residency Training: Definitions, Skills, Education and Assessment. Acad Radiol 2002; 9:721-726.
4.
Morowitz SA. Development and Assessment of a Radiology Core Curriculum in Health Care Policy and Practice. Acad Radiol 2000; 7:540-550.