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Critical Core Competency

Rajiv Y. Chandawarkar, MD; Shiv Taylor, MD; Peter Abrams, MD; Andrew Duffy, MD; Anthony Voytovich, MD; Walter E. Longo, MD; Robert A. Kozol, MD

Arch Surg. 2007;142(3):222-226.

Hypothesis  Resident core competence can be improved by learning to accurately estimate the costs of postoperative complications.

Design  Prospective, institutional review board–approved study. In step 1, residents were provided 3 clinical vignettes detailing specific treatment measures for postsurgical complications and asked to assign total cost estimates for the treatment for each vignette; in step 2 they were given a pocket-sized cost card listing hospital costs, and in step 3, after 2 weeks, they were retested using the same clinical vignettes as in step 1.

Setting  University of Connecticut, Farmington, and the Yale University School of Medicine, New Haven.

Participants  Fifty-three general surgery residents.

Main Outcome Measures  Cost estimates for steps 1 and 3 were compared using the paired t test and analysis of variance to examine whether there is a difference between the baseline cost estimates and the actual cost; whether introduction of the cost card improves performance; and whether responses correlate to postgraduate year level or to the clinical vignette.

Results  There was a statistically significant difference between the baseline cost estimates (before introduction of the cost card) and the actual cost of the treatment (P = .03). Introduction of the cost card resulted in a statistically significant improvement between the cost estimates before and after the intervention (P = .002), with a drop in average percentage error by 35% (range, 32%-38%). Level of postgraduate training or type of test vignette (at analysis of variance) did not seem to be a significant factor.

Conclusions  There is a lack of awareness among surgical residents of the cost of treatment of postoperative complications. Introduction of a simple educational tool such as a cost card measurably improves their overall understanding of the cost of care and can be easily incorporated into the residency curriculum.

Author Affiliations: Division of Plastic Surgery (Dr Chandawarkar) and Departments of Medicine (Dr Voytovich) and Surgery (Drs Taylor and Kozol), University of Connecticut School of Medicine, Farmington; and Department of Surgery, Yale University School of Medicine, New Haven, Conn (Drs Abrams, Duffy, and Longo).