Web-based curriculum improves surgical residents' knowledge of health care business

The expectation is for residents to "demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care." However, consensus from residents is that they lack instruction and feel ill prepared in practice management and the business of health care. Furthermore, program directors report that approximately 70 percent of their residents are not adequately trained in these areas.

Current curricular options for teaching and evaluating outcomes in this space are limited. To address these issues, experts in business and surgery collaborated to develop the Web-based curriculum.

"Residents have told us they lack instruction in practice management and the business of health care and feel underprepared for when they leave the training environment," said Linnea S. Hauge, PhD, the study's lead author and assistant professor of surgery at the University of Michigan Medical School, Department of Surgery in Ann Arbor, MI. "Given the growing time restrictions in surgery training, the flexibility of Web-based learning is attractive to both surgical educators and residents."

Twenty-eight postgraduates in their third to sixth year as general and plastic surgery residents were enrolled in the program. Twenty-two residents (79%) completed the pre-test, 11 modules, the post-test and the course evaluation by the end of one year. The pre-test and the post-test consisted of 30 item multiple-choice exams based on a blueprint of the curricular objectives.

The study found that residents' performance on the multiple choice exam improved significantly from the pre-test (mean 59%) to the post-test (mean 78%), with an average gain of 19 percentage points. Participants rated their Web-based learning experience as very positive, with a majority of residents agreeing that the content was well organized, relevant, and an excellent learning experience around content not taught elsewhere in medical school or residency.

The Web-based curriculum was determined to be a feasible and effective method for teaching and assessing systems-based practice concepts. In this study, residents reported they preferred Web-based learning and spent less time vs. paper-based learning.