Addressing the systems-based practice requirement with health policy content and educational technology

Figures & data

Table

Practice points

Health policy content is missing from medical education curriculum. Health policy content meets the ACGME competency of “systems-based practice.” Residents and fellows prefer a hybrid format of delivery over strictly live lecture or web/podcasts. Interdisciplinary interaction between residents and fellows enhances their educational experience.

Table 1.  Topics for health policy lecture series for Years One and Two

Year One	Year Two
Health Policy series	Health Policy series	Health Law, Ethics and Global Health series
Private Health Insurance	Health Macro-Economics	End of Life Care
Medicare	Physician Payment	Conflicts of Interest
Medicaid, SCHIP and the Uninsured	Private Health Insurance	Research Ethics: The Jesse Gelsinger Case
Health Care Disparities	Medicare	Global Health: Introduction to Global Health
Health Care Policy and 2008 Candidates	Medicaid, SCHIP, Uninsured	Global Health: Comparative Health Systems
End of Life and LTC	Health Policy and the Obama Administration	Introduction to Law and Medicine
Comparative Health Care Systems	Health Information Technology	Law and Medicine: Tort and Medical Malpractice
Health IT	Quality and Pay for Performance	Employment and Contract Law
Quality and Pay for Performance	Technology: Drugs and Devices	Biases
Technology: Drugs and Devices		Medical Decision-Making
Conflict of Interests
Health Care Costs and Projections
Physician Payment
Hospital Payment

Table 2.  Participant explanation for selected method of participation

Traditional live lecture	Web/podcast
Easier to be more alert in a lecture and easier to zone out while listening to an iPod	Its all about time and convenience
More meaningful if there is direct interaction with the presenter	Podcast allows you to pause, rewind, play again
If important topic, it's important to be present	There is no time for extra lectures – can’t even get to the ones scheduled in own program
Seated is always better – if there is time	Risk falling asleep in a lecture, but can control the podcast and focus
On-line courses can be boring with no interaction	It is less distracting. In residency lectures, there are pagers going off and people moving in and out
It is important to be able to ask questions at the right time	Can listen or watch and do it any time or place
There is a huge educational value attached to the in-person interactions	Can listen while doing something else
	Ideally, content could be offered using a combination of methods

Table 3.  Evaluation outcomes

	Live lecture (n = 24)^a		Webcast (n = 21)^a		Podcast (n = 66)^a
Presentation format	Below expectations	0%	Below expectations	0%	Below expectations	3.0% (2)
	Met expectations	33.3% (8)	Met expectations	52.4% (11)	Met expectations	45.5% (30)
	Above expectations	66.7% (16)	Above expectations	47.6% (10)	Above expectations	50% (33)
Benefit to me	Below expectations	12.5% (3)	Below expectations	9.5% (2)	Below expectations	1.5% (1)
	Met expectations	41.7% (10)	Met expectations	33.3% (7)	Met expectations	40.9% (27)
	Above expectations	45.8% (11)	Above expectations	57.1% (12)	Above expectations	56.1% (37)
Use of my time	Below expectations	12.5% (3)	Below expectations	9.5% (2)	Below expectations	0%
	Met expectations	41.7% (10)	Met expectations	42.9% (9)	Met expectations	47% (31)
	Above expectations	41.7% (10)	Above expectations	47.6% (10)	Above expectations	51.1% (34)
Session overall	Below expectations	4.2% (1)	Below expectations	4.8% (1)	Below expectations	0%
	Met expectations	41.7% (10)	Met expectations	38.1% (8)	Met expectations	45.5% (30)
	Above expectations	54.2% (13)	Above expectations	57.1% (12)	Above expectations	53% (35)

Note: ^aIt is not known how many different individuals responded as these were anonymous evaluations and responses cannot be tracked to an individual.

Table 4.  Performance on post-test by participants in Years One and Two

	Year One		Year Two
	Live lecture	Web/podcast	Health policy	Health law, ethics and global health
Number of participants^a	3	21	10	4
Mean score range	50–100%	40–100%	42–100%	75–100%
Mean score overall	82%	82%	85%	88%

Note: ^aSome participants did not complete the post-test(s) (chose not to or graduated).