Recent survey data revealed that most radiology residents cannot estimate imaging costs within 50 percent of accepted Medicare fees. Armed with this eyebrow-raising insight, researchers from Harvard and Brown Universities have studied the use of iPad apps for teaching tech-savvy millennials the basics of healthcare economics. Their conclusion: The approach works.

Lead author Ana Lourenco, MD, of Brown affiliate Rhode Island Hospital, along with colleagues at Harvard’s Beth Israel Deaconess Medical Center, present their findings in the July edition of Academic Radiology.

The team conducted an initial survey assessment of 69 radiology residents’ knowledge of healthcare economics milestones before and following review of an educational iPad app created by one of the study authors. The app covers economics milestones from the perspective of a patient being imaged in a radiology department.

Among other learning and assessment steps, the residents used an electronic link to respond anonymously to 13 general-knowledge questions, such as:

1. With regard to medical reimbursement, what does RVU stand for?
2. The ‘professional component” of radiology reimbursement refers to the fees for [what]?
3. In healthcare payment terminology, who is typically referred to as the second party?

There was also a self-assessment component covering perception of knowledge, plus a didactic conference in which the residents reviewed the app on their mobile devices.

Immediately after completing the program and again three months later, the residents filled out a follow-up survey to assess how much of the content they’d retained.

Some 62 of the 69 residents (90 percent) completed the initial survey, while 59 completed the immediate post-survey and 60 completed the three-month follow-up.

Among the results:  

• The residents’ mean self-assessment of their knowledge of healthcare economics milestones was fair on the pre-survey, significantly improved on the post-survey and plateaued at three months.
• Residents demonstrated a significant increase in healthcare economics knowledge on post-survey.
• At the three-month follow-up, significant decreases in gained knowledge were observed only in residents for whom the material was not integrated into the curriculum.

“After completing the iPad curriculum, residents at both programs substantially increased their healthcare economics knowledge, and the resulting knowledge gained was not significantly different between the two programs,” Lourenco et al. write in their discussion.

There was one blip, though. At three-month follow-up, residents from one of the two sites demonstrated a significant decrease in healthcare economics knowledge, whereas no difference was observed for residents from the other site.

“We postulate that this effect is likely related to additional healthcare economics lectures,” the authors write, “which are routinely integrated into the rotating two-year curriculum at site 1 but do not exist at site 2.”

The authors further observed that, although residents’ preferred method of learning healthcare economics did not change, their self-assessment of healthcare economics milestones improved significantly following review of the iPad app material.

Meanwhile, performance on the 13 knowledge-based questions also improved significantly.

“This increase in knowledge is expected as most educational interventions result in learning of at least a portion of the material,” the authors write. “However, as the exercise was interactive, the learning and retention of the material was likely more substantial than a didactic lecture.”

The team acknowledges small sample size and less-than-100 percent participation as limitations in their study design.

They conclude that the use of an iPad app “is an effective alternative method to teach the content of the healthcare economics milestones. In the future, this may be particularly useful in programs with too few educators or with insufficient experience in the area of healthcare economics.”

Still, given the differences in retention seen at the two different programs, “it is clear that, for maximal memory maintenance, continued and intermittent exposure to the material is essential.”