V. Martinez-Vargas1,2, B. Smith1 1University Of Utah,Division Of Vascular Surgery,Salt Lake City, UT, USA 2University Of Puerto Rico School Of Medicine,San Juan, Puerto Rico, USA
Introduction:
Accrediting bodies in medical education have recognized the importance of physician competence in value-driven healthcare (VDH) concepts, including quality improvement, patient safety, service, and cost-containment. A complete VDH curriculum in general surgery residency does not exist and little is known about graduates’ perceived need for this program. The objective of this study was to describe the perceptions of general surgery residency program graduates regarding the need for education in VDH.
Methods:
We developed a survey to assess recent surgery residency graduates’ perceptions of the VDH education they received during training, as well as the importance of knowledge and skills in VDH in their current clinical practice. Survey items were developed through discussion with VDH experts and the survey was piloted with current residents for clarity. The survey was emailed to graduates of the University of Utah General Surgery Residency program who completed residency from 2012-2016 (n=23). Data were collected using REDCap (Research Electronic Data Capture). Descriptive statistics and qualitative analysis were applied to summarize results.
Results:
Thirteen of the 23 graduates responded to the survey (57% response rate). Half of respondents felt that they received formal instruction in VDH during residency, but 11 (85%) agreed that the amount of instruction on VDH was adequate. All respondents were involved in a Quality Improvement (QI) project during residency, and 8 respondents (60%) led one. Only 8 respondents (63%) described their QI project as a positive experience. Eleven respondents (85%) felt that they had adequate skills and knowledge to lead a QI effort. When asked what an ideal VDH curriculum would include, the majority felt that cost containment, patient safety, and QI should be included (11 [85%], 10 [77%],and 9 [62%], respectively), while 6 (46%) wanted the opportunity to lead a QI project. Qualitative analysis of free text responses revealed lack of understanding of QI methods and frustration with being asked to “do more work” during residency. The majority of respondents agreed that knowledge and practical skills in VDH are important to their day-to-day clinical practice (92% and 77% respectively).
Conclusion:
While recent general surgery residency graduates value knowledge in VDH concepts in their current practice, many did not have a positive experience with QI projects and even fewer expressed interest in leading QI efforts. Given that QI work is valued by modern health care systems, our results suggest a need to improve our existing VDH training program. Follow-up studies collaborating with other institutions would help assess the scope of this problem.