48x48 Poster Template

1
Business of Radiology 101 The State of Radiology
Business Practice Healthcare Policy Curricula
at US Radiology Residency Programs Tang J, Dicks
DL, Kohr JR, Stratil PG, Cinelli CM, Monroe EJ,
Medverd JRThe University of Washington
Department of Radiology, Seattle, Washington.
OPTIONALLOGO HERE
Results Continued
Results Continued
Background
Non-interpretive Curriculum Topics Topics most
often reported as included in non-interpretive
curricula are summarized below. Additional topics
reported under the heading Other included
physician fatigue, physician impairment,
disclosure policies practice, publication
article review, statistical and critical
literature review, patient safety ethics, and
military related discussions. Topics receiving at
least 50 prevalence within any survey are
highlighted in yellow.

The United States (US) has been experiencing a
period of rapid changes in healthcare delivery
and financing. It has been asserted that the
future career success, as well as job
satisfaction, of todays radiology resident
hinges as much upon developing excellence in the
performance and interpretation of radiological
examinations as acquiring awareness of the larger
context and system of health care and the ability
to effectively call upon system resources to
provide care of optimal value 1. Despite the
importance of these non-interpretive skills,
radiologists have generally not been trained in
basic business principles and regulatory trends
while in residency. Several individual residency
curriculum proposals have been published over the
past decade which include suggestions for a
thorough curriculum in business and policy
principles 1-4. Furthermore, organizations such
as the Association of Program Directors in
Radiology (APDR), the Radiological Society of
North America (RSNA), and the American College of
Radiology (ACR) have supported initiatives to
assist programs with these educational
requirements. Despite these steps, effectively
incorporating the wide array of topics included
in non-interpretive curricula into a residency
can be difficult and it is unclear to what extent
all US residency programs have addressed these
requirements or what methods are being used.
Perceived Importance of Non-interpretive
Curriculum Responses to the questions do you
feel developing an understanding and element of
command of radiology business topics and
healthcare policy topics and their impact on
radiology practices will be important to resident
future careers? indicate program director and
resident groups agree that a non-interpretive
curriculum is important to the future careers of
residents. APDR

RFS Delegates
Topic APDR RFS Del RFS Member
Medical - legal issues 74 56 57
Quality 71 64 56
Medical and business ethics 67 39 52
Radiology Informatics 67 44 42
Contracts, negotiation 60 44 40
Medical billing and reimbursement 57 53 47
Evidence - based radiology 52 39 56
Leadership, communication skills 50 28 31
Health care policy 47 53 54
Personal finance 31 33 41
Performance metrics 24 25 17
Practice governance, organizational models 19 14 23
Accounting principles/financial statements 16 22 18
Strategic planning 12 11 16
Other topic(s) (please specify) 7 0 0
Purpose
 To assess the prevalence, content and perceived
effectiveness of curricula focused on radiology
business practice and healthcare policy at US
radiology residencies.
Methods
Time Allocation for Non-interpretive
Curriculum Results from APDR survey respondents.
Only 25 of residency programs allot gt12 hours
and 44 of programs spend 8 hours or less per
academic year on curricula.
Three surveys were distributed. An online survey
was sent to the membership of the APDR by email
in June 2010. A similar paper survey was
distributed to ACR Resident Fellow Section
(RFS) representatives attending the ACR Annual
Meeting Chapter Leadership Conference (AMCLC)
May 2010 (RFS Delegates). An abbreviated
online survey was sent to the entire ACR RFS
membership by email in December 2009 with a
second request in April 2010 (RFS Members).
These questions were included as subsection of a
larger survey exploring quality issues in
residency training performed as a function of an
ACR Quality Fellowship experience by two of our
authors (CMC, JRK).   Email surveys were
anonymous and collected over several weeks.
However, the majority of responses were logged
close to the date of invitation. Paper surveys
were anonymously collected on the same day as
distributed.
Discussion
Program directors and residents value radiology
business practice and healthcare policy
education, but our data on perceived
effectiveness of individual program educational
efforts suggest that current curricula, while
providing some value, are suboptimal when not
absent. Barriers to excellence in the delivery of
these curricula include a current lack of
consensus on curriculum, evolving best practices
for curricula delivery, and absence of
established outcomes measurement methodologies.
Identification of time to address
non-interpretive curricular goals within the
competing constraints of modern radiology
residency programs is also a significant
challenge.  APDR survey responses suggest that
many curricula in use at radiology residency
programs today do not provide a thorough overview
of topics germane to radiology business practice
and healthcare policy. Topics of medicolegal,
quality, medical business ethics, radiology
informatics, contracts negotiation, medical
billing reimbursement, and evidence-based
radiology were widely addressed (gt50 responding
programs reporting inclusion). However,
instruction in the soft skills of leadership
communication, health care policy, practice
governance organizational models, and strategic
planning, as well as the hard skills of
accounting principles, performance metrics and
personal finance may currently be underemphasized
(lt50 responding programs reporting inclusion).
Our survey instruments, designed for brevity,
unfortunately do not provide insight into the
underlying cause. Future curricular efforts, if
envisioned to be comprehensive, must provide
exposure to the above identified
underrepresented, yet equally important, topics.
Residency training requirements in competencies
related to radiology business practice and
healthcare policy have been in place for over a
decade. These survey data provide insight into
the level of adoption and content of curricular
efforts currently in place within US radiology
residency programs, and suggest that there is
room for improvement. Further commitment to and
innovation within these curricula are needed.
Results
Educational Modalities Modalities used most often
included didactic lectures (96), journal clubs
(42), small group activities (21), discussion
panels (10), and online materials (lt10).
Distribution Response Rates Attendance lists
indicate that 210 RFS delegates registered for
the 2010 ACR AMCLC. 150 paper surveys were
distributed to delegates present at sessions when
surveys were solicited. At time of invitation,
membership email roster lists were APDR 315, ACR
RFS 3,530. Survey response rates were APDR 20
(64/315), RFS Delegates 37 (56/150), and RFS
Members 12 (439/3,580).   Geographic
Representation Distribution of responses
generally mirrored the national balance of ACGME
accredited US radiology residency programs.
Perceived Efficacy of Non-interpretive Curriculum
APDR and both RFS groups were asked to rate the
effectiveness of non-interpretive curricula in
use at their institutions. Respondents most
often rated curricula as moderately effective
(45, 58 respectively), followed by marginally
or minimally effective (31, 25). Both groups
infrequently rated their curricula as very
effective (12, 6). APDR


RFS
References
Otero HJ, Weissman BN, Rybicki FJ. System-based practice proposal for a comprehensive curriculum. Acad Radiol 2008 15119-126. Chan S. Management Education During Radiology Residency Development of an Educational Practice. Acad Radiol 2004 111308-1317. Collins J, Rosado de Christenson M, et al. General Competencies in Radiology Residency Training Definitions, Skills, Education and Assessment. Acad Radiol 2002 9721-726. Morowitz SA. Development and Assessment of a Radiology Core Curriculum in Health Care Policy and Practice. Acad Radiol 2000 7540-550.

Prevalence of Non-interpretive Curriculum Program
director (APDR) responses to the question does
your residency have a curriculum addressing non
interpretive topics? suggest that 91 of US
radiology residencies include elements of these
curricula at their programs.