JACR: Business, healthcare policy education may fail rads of the future

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Residency training requirements in competencies related to radiology business practice and healthcare policy have been in place for more than a decade. However, despite the perceived importance of such competencies, curricula addressing these items still seem to be in a stage of acceptance and development, with further commitment and innovation needed, according to a study published in the March issue of the Journal of the American College of Radiology.

“The U.S. has been experiencing a period of rapid change in healthcare delivery and financing. Institutions and individuals have been repeatedly challenged to successfully adapt to the accelerating technological, professional and competitive pressures of the dynamic U.S. healthcare marketplace. Nowhere is this more true than within diagnostic imaging,” Jonathan R. Medverd, MD, of the University of Washington in Seattle, said in a statement.

In order to assess the prevalence, content and perceptions of radiology business and healthcare policy curricula, Medverd and colleagues distributed three anonymous surveys—an email survey to the membership of the American College of Radiology (ACR) Resident and Fellow Section (RFS), a paper survey to ACR RFS delegates attending the 2010 ACR Annual Meeting and Chapter Leadership Conference and an email survey to the membership of the Association of Program Directors in Radiology (APDR).

Results showed that members of the APDR and RFS agreed that understanding and competency in business practice and healthcare policy topics are important to the future careers of residents, as more than 86 percent of APDR members found that sentiment favorable along with more than 96 percent of RFS members.

Ninety-one percent of APDR respondents and 74 percent of RFS respondents said their home institutions offer some form of a noninterpretive curriculum, but the breadth of topics addressed and educational time devoted to these curricula varied greatly. Subjective effectiveness of curricula was infrequently rated as very effective—12 percent of APDR and 6 percent of RFS respondents rated their institutions’ curricula as such. Most often curricula were rated as moderately effective (45 percent of APDR respondents and 52 percent of RFS respondents).

“National accrediting authorities, radiology program directors, and radiology residents and fellows all value business practice and healthcare policy education, but our data on the perceived effectiveness of individual program educational efforts suggest that current curricula, although providing some value, may be suboptimal when present,” wrote the authors.

The authors said that noninterpretive topics such as medicolegal issues, quality, medical and business ethics, radiology informatics, contracts and negotiation, medical billing/reimbursement and evidence-based radiology were widely addressed in many residency programs. However, the soft skills of leadership, healthcare policy and practice governance, along with the hard skills of accounting principles, performance metrics and personal finance are currently underemphasized.

Medverd et al acknowledged that the wealth of knowledge that must be mastered during residency is formidable and that finding time to address curricular goals is a challenge, but suggested that the training environment could be hybridized to include opportunities for noninterpretive learning while simultaneously contributing to clinical rotations.

“Nationally, medical students consistently report that they receive inadequate instructional time devoted to the practice of medicine,” they wrote. “If education within foundation topics and skills common to practice management within all specialties could be initiated during undergraduate medical education, time to address specialty-specific and advanced topics during residency may be facilitated.”