a General Internal Medicine , Yale University School of Medicine , New Haven , Connecticut , USA.
Teach Learn Med. 2014;26(1):90-4. doi: 10.1080/10401334.2013.857338.
The Accreditation Council for Graduate Medical Education and American Board of Internal Medicine have identified cost-awareness as an important component to residency training. Cost-awareness is generally not emphasized in current, traditional residency curricula despite the recognized importance of this topic.
Using a traditional Morning Report structure and actual charge data from our institution, the charges associated with trainee-directed workup of clinical cases are compared in a friendly competition among medical students, interns, residents, and faculty.
Anonymous, voluntary survey of all participants and comparison of expenditures by training level were used to assess this pilot program. The educational quality of the I-CARE was rated higher than the prior format of Morning Report by participants (10-point Likert scale; 8.57, 6.81 respectively; p < .001). Open-ended comments were overwhelmingly supportive from faculty and trainees. Cost was lower for attending physicians than for trainees ($1,027.45 vs. $4,264.00, p = .02) and diagnostic accuracy was also highest for attending physicians.
The I-CARE is easy and quick to implement, and the preliminary results show a popular cost-awareness educational experience for internal medicine trainees. Further study is needed to determine change in practice habits.
毕业后医学教育认证委员会和美国内科医师学会已经将成本意识确定为住院医师培训的一个重要组成部分。尽管这个话题很重要，但在当前的传统住院医师课程中，通常不会强调成本意识。
使用传统的晨间报告结构和我们机构的实际收费数据，在医学生、实习生、住院医师和教师之间进行了一场友好的竞赛，比较了由学员主导的临床病例检查的相关费用。
采用匿名、自愿调查所有参与者的方式，并比较培训水平的支出，以此来评估这个试点项目。参与者（10 分李克特量表；分别为 8.57、6.81；p<0.001）认为 I-CARE 的教育质量高于之前的晨间报告形式。教师和学员的反馈意见也压倒性地支持这一项目。主治医生的费用比住院医师低（1027.45 美元对 4264.00 美元，p=0.02），诊断准确率也最高。
I-CARE 易于实施且快速，初步结果表明，这是一个针对内科住院医师的受欢迎的成本意识教育体验。需要进一步研究以确定实践习惯的改变。
