Hadley Morgan, Jardaly Achraf, Paul Kyle, Ponce Brent, Wise Brent, Patt Joshua, Templeton Kimberly
Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas.
Department of Orthopaedic Surgery, St. Louis University, St. Louis, Missouri.
JB JS Open Access. 2023 May 30;8(2). doi: 10.2106/JBJS.OA.22.00111. eCollection 2023 Apr-Jun.
Costs of healthcare in the US continue to rise at rates that are unsustainable. Prior studies, most of which come from non-surgical specialties, indicate that a variety of strategies to teach this material are utilized but without consensus on best practices. No studies exist regarding the teaching of cost-effective care in orthopaedic residency training programs. The goal of this study was to assess the landscape in this area from the perspective of program leadership.
A survey was developed that was sent to orthopaedic residency program leadership via email through their interaction with the COERG. Additional programs were included to enhance diversity of responding programs. The survey, based on those published from other areas of medicine, included questions about the experiences of the respondents in learning about cost-effective care, as well as how faculty and residents learned about this topic.
Seventy one percent (30) of respondents noted that their faculty did not receive formal training in cost-effective care, and education in this area was likely to come from the department, especially review of practice data (12, 44%). Only 19% (8) of respondents agreed with the statement that "the majority of teaching faculty in our program consistently model cost-effective healthcare to residents". Few of the programs (10, 24%) had formal curricula for residents regarding cost-effective care, and the primary mode of education in cost-effective care was through informal discussions with faculty (17, 43%). Few residents (3, 13%) were able to easily find the costs of tests or procedures.
There is not consistent education in cost-effective care for orthopaedic surgery program leadership, faculty, or trainees. The results of this survey demonstrate a need for discussion of best practices, including increasing access to cost data at a local level, and engaging with the AOA, CORD, and the American Academy of Orthopaedic Surgeons more broadly in the development of standard education modules for faculty and residents, to improve the current and future delivery of cost-effective musculoskeletal care.
美国医疗保健成本持续以不可持续的速度增长。先前的研究大多来自非外科专业，表明人们采用了多种教授该内容的策略，但对于最佳实践尚无共识。关于骨科住院医师培训项目中具有成本效益护理教学的研究尚未存在。本研究的目的是从项目负责人的角度评估该领域的情况。
制定了一项调查问卷，通过与骨科教育研究小组协作（COERG），以电子邮件形式发送给骨科住院医师培训项目负责人。纳入了其他项目以增强回复项目的多样性。该调查问卷基于医学其他领域发表的内容，包括有关受访者学习具有成本效益护理的经历，以及教员和住院医师如何学习该主题的问题。
71%（30）的受访者指出，他们的教员未接受过具有成本效益护理方面的正规培训，该领域的教育可能来自科室，尤其是实践数据的审查（12人，44%）。只有19%（8）的受访者同意“我们项目的大多数教学教员始终向住院医师示范具有成本效益的医疗保健”这一说法。很少有项目（10个，24%）为住院医师制定了关于具有成本效益护理的正规课程，具有成本效益护理的主要教育方式是与教员进行非正式讨论（17人，43%）。很少有住院医师（3人，13%）能够轻松找到检查或手术的费用。
对于骨科手术项目负责人、教员或学员，在具有成本效益护理方面没有一致的教育。本次调查结果表明需要讨论最佳实践，包括增加在地方层面获取成本数据的机会，并更广泛地与美国骨科协会（AOA）、骨科教育委员会（CORD）和美国骨科医师学会合作，为教员和住院医师开发标准教育模块，以改善当前和未来具有成本效益的肌肉骨骼护理服务。
