OBJECTIVE: The goal of this study was to explore how prepared psychiatry programs are to teach residents to practice resource management and high-value, cost-effective care. METHODS: An anonymous online survey was sent to 187 psychiatry training directors between July and September 2015. RESULTS: Forty-four percent of training directors responded to the survey. While most training directors who responded (88%) agreed that that graduate medical education has a responsibility to respond to the rising cost of health care, fewer than half agreed that that their faculty members consistently model cost-effective care (48%), that residents have access to information regarding the cost of tests and procedures (32%), and that residents are prepared to integrate the cost of care with available evidence when making medical decisions (44%). Only 11% reported providing training in resource management. Barriers cited to teaching cost-effective care included a lack of information regarding health care costs (45%), a lack of time (24%), a lack of faculty with relevant skills (19%), and competing training demands and priorities (18%). Training directors also noted a lack of available curricular resources and assessment tools (21%). Another 12% cited concerns about cost containment overriding treatment guidelines. Ninety percent of training directors agreed that they would be interested in resources to help teach high-value, cost-effective care. CONCLUSIONS: Most psychiatry programs do not provide formal training in resource management but are interested in resources to teach high-value, cost-effective care. Curricula for residents and faculty may help meet this need.
Detsky AS, Verma AA. A new model for medical education: celebrating restraint. JAMA. 2012;308(13):1329–30.
[DOI: 10.1001/2012.jama.11869]
Weinberger SE. Providing high-value, cost-conscious care: a critical seventh general competency for physicians. Ann Intern Med. 2011;155:386–8.
[DOI: 10.7326/0003-4819-155-6-201109200-00007]
American Board of Internal Medicine Foundation. Choosing wisely. choosingwisely.org . Accessed February 25, 2020.
Cooke M. Cost consciousness in patient care—what is medical education’s responsibility. N Engl J Med. 2010;362:1253–5.
[DOI: 10.1056/NEJMp0911502]
Rosenbaum L, Lamas D. Cents and sensitivity — teaching physicians to think about costs. N Engl J Med. 2012;367:99–101.
[DOI: 10.1056/NEJMp1205634]
Jardine D, Deslauriers J, Kamran SC, Khan N, Hamstra S, Edgar L. Milestones guidebook for residents and fellows. Accreditation Council for Graduate Medical Education. 2017. https://www.acgme.org/Portals/0/PDFs/Milestones/MilestonesGuidebookforResidentsFellows.pdf . Accessed January 11, 2020.
Accreditation Council for Graduate Medical Education and the American Board of Psychiatry and Neurology. The Psychiatry Milestone Project. July 2015. https://www.acgme.org/Portals/0/PDFs/Milestones/PsychiatryMilestones.pdf . Accessed August 27, 2019.
Accreditation Council for Graduate Medical Education and the American Board of Internal Medicine. The Internal Medicine Milestone Project. July 2015. https://www.acgme.org/Portals/0/PDFs/Milestones/InternalMedicineMilestones.pdf . Accessed September 4, 2019.
Accreditation Council for Graduate Medical Education, the American Board of Obstetrics and Gynecology, and the American College of Obstetrics and Gynecology. The Obstetrics and Gynecology Milestone Project. September 2015. https://www.acgme.org/Portals/0/PDFs/Milestones/ObstetricsandGynecologyMilestones.pdf Accessed September 4, 2019.
Accreditation Council for Graduate Medical Education and the American Board of Family Medicine. The Family Medicine Milestone Project. October 2015. https://www.acgme.org/Portals/0/PDFs/Milestones/FamilyMedicineMilestones.pdf . Accessed September 4, 2019.
Patel MS, Reed DA, Loertscher L, McDonald FS, Arora VM. Teaching residents to provide cost-conscious care: a national survey of residency program directors. JAMA Intern Med. 2014;174(3):470–2.
[DOI: 10.1001/jamainternmed.2013.13222]
Tchou MJ, Walz A, Burgener E, Schroeder A, Blankenburg R. Teaching high-value care in pediatrics: a national survey of current practices and guide for future curriculum development. J Grad Med Educ. 2017;9(6):741–7.
[DOI: 10.4300/JGME-D-17-00139.1]
Accreditation Council for Graduate Medical Education. List of programs by specialty- psychiatry. https://www.acgme.org/ads/public . Accessed on July 20, 2015.
The AMA Residency and fellowship database (FREIDA™). Psychiatry. https://freida.ama-assn.org . Accessed on July 20, 2015.
Accreditation Council for Graduate Medical Education. Common program requirements (residency). Major revision: June 10, 2018; Effective: July 1, 2019. https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRResidency2019.pdf . Accessed October 15, 2019.
Clancy C, Dine CJ, Williams D, Smith CD. High value care curriculum for internal medicine residents. Am College Physicians Alliance Acad Internal Med www.acponline.org/clinical-information/high-value-care . Accessed September 5, 2019.
Arbuckle MR, Barkil-Oteo A, Asghar-Ali AA, Stern DA. Training in high-value, cost-effective care: a curriculum for psychiatry residents. Acad Psychiatry. https://doi.org/10.1007/s40596-020-01199-9 .
Barkil-Oteo A, Stern DA, Arbuckle MR. Addressing the cost of health care from the front lines of psychiatry. JAMA Psychiatry. 2014;71(6):619–20.
[DOI: 10.1001/jamapsychiatry.2014.121]
Stern DA, Barkil-Oteo A, Asghar-Ali AA, Arbuckle MR. Curriculum for SBP2: resource management. model curriculum. American Association of Directors of Psychiatric Residency Training; 2017. https://www.aadprt.org . Accessed 10 March 2020.
