G. T. Fankhauser1, J. Perone1, P. Roughneen1 1University Of Texas Medical Branch,Department Of Surgery,Galveston, TX, USA
Introduction: Value in healthcare and surgery involves the pursuit of the highest quality outcome for the resources used. This differs from cost-effectiveness which emphasizes pure outcome more than quality. The distinction is subtle but important in the current healthcare paradigm where reimbursement is often tied to outcome and resources are constrained. We sought to assess surgical resident understanding of value and the focus on it during training.
Methods: We constructed an anonymous nine-question survey and distributed it to residents in all surgical specialties at a university teaching hospital. The survey queried resident familiarity with value, its distinction from cost-effectiveness, prior education on value in healthcare, and sentiments on how much focus value should receive in training and in the healthcare system at-large. Resident surgical specialty and year of residency were recorded.
Results: 61 surveys were completed (84% response). 58% reported being unfamiliar or vaguely familiar with value in healthcare while 42% reported being fairly or extremely familiar with it. 66% reported the belief that value was the same as cost-effectiveness or unfamiliarity with the difference. 40% reported no education on value during residency with 54% reporting some education and only 6% reporting quite a bit of education. 82% of residents reported that there is not enough focus on value during training while 16% felt the amount was about right and 2% felt there was too much focus on value. In regards to the healthcare system at-large, 79% felt that there should be more focus on value and 13% felt the current focus was about right. 8% felt there should be less or no focus on value in the healthcare system at-large. By year of training, residents earlier in their training tended to have received more education on value during medical school(p=NS). Year of training did not correlate to education on value received during residency or thoughts on how much focus value should receive. There was a positive association between familiarity with value and receiving education on value during medical school(p=NS) but not during residency. Feelings toward how much focus value should receive in residency correlated with thoughts on how much focus value should receive in the healthcare system at-large(p=NS). Residents with more education on value in residency were less likely to think there is insufficient focus on value in the healthcare system at-large(p=NS). Receiving education on value and thoughts about how much focus value should receive did not correlate with surgical specialty.
Conclusion: This pilot study shows a gap in education for surgical residents on value in healthcare. Further study is needed on a national scale to assess surgical resident familiarity with value then design a curriculum accordingly. Medical schools are more recently providing education on value in healthcare but there is still a need for more education on value during surgical training.