Published 4/1/2011
Eric C. Stiefel, MD

Resident education: Healthcare policy

Residents in Florida are leading the way

The American Association of Orthopaedic Surgeons (AAOS) and state orthopaedic societies fulfill a vital role by keeping practicing orthopaedic surgeons up to date on healthcare policy issues and advocacy. But what about orthopaedic residents? How are we educating the true “grass roots” of our profession in these areas?

In Florida, a unique effort by the Florida Orthopaedic Society (FOS) and the University of Florida College of Medicine, Jacksonville, is educating residents on healthcare policy. The peer-based education program aims to provide future orthopaedic surgeons with the tools necessary to participate in healthcare policy discussions and take a role in developing solutions.

Preliminary evaluations indicate the curriculum has resulted in improving residents’ understanding of healthcare policy concepts. (See “Health policy education works” this page.) It has also raised interest in engaging in political activism. When provided with a working knowledge of the issues, residents demonstrated the ability to conceptualize and discuss complex healthcare policy topics.

Although the role of healthcare policy in contemporary resident education may be debated, in our experience, this peer-based model represents a viable means to relay the advocacy message to residents. By sharing the challenges, successes, and evolution of this experience, we hope to encourage state societies and academic leaders to explore ways to expose residents to healthcare policy and advocacy concepts.

Early opportunities for involvement
In 2008, the FOS initiated a program aimed at introducing residents to state-level advocacy opportunities, including a scholarship for a resident to travel to the annual AAOS National Orthopaedic Leadership Conference (NOLC).

I was one of two residents from the University of Florida–Jacksonville who attended the NOLC in 2010. When we returned, we approached the FOS and our academic program leaders with a concept for peer-based education. With support from FOS leaders, we initiated a resident-led advocacy education project.

Structuring the peer-based concept
A key element of our educational program was recruiting residents to deliver a formal healthcare policy and advocacy program to our colleagues. The state society assisted by providing mentors, resources, and the experience to develop a curriculum.

Given the time commitment required, it is important to identify residents who are interested in this area. The application process for the FOS NOLC scholarship includes an essay component, which allows us to identify resident advocacy leaders. To maximize the return on the scholarship, the recipient is responsible for reporting key concepts from the NOLC to his or her residency program.

Florida has five orthopaedic residency programs. Using this mode of delivery, over the 5 years required to complete orthopaedic training, this peer-based education model has the potential to reach every Florida trainee before he or she completes their residency training.

The program on health policy is directly relevant to the Accreditation Council on General Medical Education’s core competency of systems-based practice. Healthcare policy education is one way to increase resident awareness of the challenges facing the U.S. health care system, and how they can have an impact on the system’s efficiency through their daily practice.

To provide resident participants with an active learning environment and deliver the program in a familiar venue, we decided to use a journal club meeting and a grand rounds presentation. Feedback from resident surveys reported both venues to be beneficial. The final “healthcare policy primer” accounted for 5 hours of scheduled academic programming, and the entire curriculum was structured and delivered by residents, with program mentors approving the content.

Journal club
The interactive format of a journal club setting was our primary means of educating residents. The reading list was divided into four healthcare “domains:” U.S. healthcare performance and reform, health information technology and patient-centered imaging, medical liability and defensive medicine, and reimbursement. Residents were divided into four teams, and each team was responsible for leading the discussion and interpretation of the assigned readings from one domain.

Readings came from scientific publications, articles from AAOS Now, and the formal position statements from the AAOS. Although the size and content of the reading assignments was challenging, the inclusion of scientific literature was important to teach residents how to analyze the hard data behind the policy debates and reform legislation.

The nonscientific commentary (AAOS Now articles and AAOS position statements) helped to condense the issues and added a component of expert opinion to the discussion. In fact, these readings were considered by many to be the most relevant as reliable review resources.

Educators may consider including selections from AAOS Now or similar publications in their regular journal club meetings. Alternatively, state societies and the AAOS may be able to identify publications relevant to the resident health care policy discussion.

The expertise and time required to maintain an up-to-date healthcare policy journal club may present a challenge in some settings; however, routine inclusion of commentary from reputable physician policy publications can expose residents to current topics.

Moving forward
As we were developing our program, we had an additional opportunity to engage the resident community via an FOS committee appointment. This formal recognition has served both as an incentive and a source of accountability for communication of the advocacy message. Now, residents have formal positions on the FOS Legislative and Political Action Committees. This provides a communication link between the state society and academic programs, which appears to be mutually beneficial and results in unique opportunities for orthopaedic residents.

This year, we hope to establish advocacy leadership opportunities for residents at all accredited orthopaedic programs in Florida. The infrastructure needed to present residents with similar opportunities is already in place within state and regional orthopaedic societies throughout the country. We believe that early exposure to state-level proceedings has the potential to redefine the role of orthopaedic surgeons in future healthcare reform efforts.

Given recent history, the interest of our patients and profession will be best served by members from our ranks. This education concept appears to be successfully delivering the advocacy message and providing residents with the tools and motivation to engage in the political discussion. Providing residents with an understanding of the challenges facing the healthcare system can help prepare them for their future role in developing solutions. As today’s orthopaedic leaders continue to work with political leaders to improve the U.S. healthcare delivery system, advocacy education for residents may provide future professionals with a head start on the debate.

Eric C. Stiefel, MD, is a PGY 4 orthopaedic resident at the University of Florida School of Medicine in Jacksonville, Florida. He would like to thank FOS President Andrew M. Wong, MD, and University of Florida faculty member and FOS executive officer Michael Suk, MD, for their role in developing advocacy leadership opportunities for Florida’s orthopaedic residents.