In April 2011, we reported on a resident-focused healthcare policy education program sponsored by the Florida Orthopaedic Society (FOS). (See “Resident education: Healthcare policy,” AAOS Now, April 2011.) This peer-based learning concept is based on recruiting orthopaedic residents to accompany the FOS delegation to the National Orthopaedic Leadership Conference (NOLC), with the expectation that the residents exposed to this unique leadership opportunity will share their experiences with their colleagues.
To give this grass-roots concept some structure, several resident training programs have already set aside educational time for residents to discuss contemporary healthcare policy issues in the academic setting. These healthcare policy education modules have been delivered using several traditional medical education venues—journal clubs, didactic sessions, and grand round presentations. They’ve covered a wide variety of issues—ranging from those that are supported by the American Association of Orthopaedic Surgeons (AAOS) on a national level to regional concerns for advocates and legislators within the state of Florida.
We have observed that this peer-based education model not only provides residents with an opportunity to discuss contemporary social and political issues but also encourages their engagement in professional advocacy.
Expanding the educational concept
The details of the education program and preliminary findings from the University of Florida School of Medicine–Jacksonville healthcare policy education research project were presented at the 2011 FOS annual meeting. This sparked the interest of other residency programs in the state and resulted in an opportunity to expand the education and leadership initiative to additional institutions.
In August 2011, the University of South Florida (USF) orthopaedic department held its inaugural healthcare policy education program. The UF–Jacksonville program will hold its second annual healthcare policy program this spring, and this year’s FOS resident delegate to the NOLC will be selected from the University of Miami program. With three of the five orthopaedic residency programs in the state of Florida participating within the first year of the program’s inception, the momentum appears to be building behind this grassroots advocacy concept.
Adam S. Bright, MD, FOS president, noted the commitment of the organization to continue to expand and develop this program in the coming year. “Our resident members deserve a great deal of credit for advancing the goals and reach of this important program,” he said. “This is an era of significant change and advancement in the delivery of medicine. The future generation of orthopaedic surgeons will have an enormous opportunity to shape the delivery of health care in our nation. It is comforting to see our young leaders engaged in the process and prepared to face these challenges.”
USF Ortho’s experience
The USF department of orthopaedics demonstrated how easy it is to implement a resident-lead healthcare policy education program. Among those in attendance were Edward S. Homan Jr, MD, a USF faculty member who served in the Florida State House of Representatives, 2002–2010; Fraser Cobbe, FOS executive director, and Eric Stiefel MD, a UF-Jacksonville resident physician who helped develop the program.
The program began with an evening journal club, which used articles on medical malpractice, healthcare expenditures, reimbursement trends, and patient-centered imaging, as well as AAOS position statements and selected readings on hot topics such as the Patient Protection and Affordable Care Act, accountable care organizations (ACOs), the Independent Payment Advisory Board, and reforming the sustainable growth rate (SGR) formula. The debate was lively and the topics fueled discussion.
The next morning, Dr. Stiefel presented a grand rounds lecture on ACOs and the Medicare Shared Savings Program. A presentation on the role of orthopaedic surgeons in patient advocacy concluded the program, which received positive responses from both USF residents and faculty.
Following the meeting, Dr. Ho-man advocated for continued resident involvement in political discussions. He highlighted the importance of engaging physicians at the resident level, saying, “It is good to see our residents paying attention not only to their patients, but also to the environment in which they will ultimately practice, particularly the political environment. What they have recognized is that very few physicians attempt to improve their environment, but a lot of them certainly complain about it.
“It is good to see young orthopaedic surgeons taking the initiative to change other physicians’ attitudes about politics in general, and medical politics specifically,” continued Dr. Homan. “Presently, there is little-to-no instruction in the politics that have such a great impact on the practice of medicine. Several of our residents want to change that so that physicians can play a more active role in deciding their fate. Every residency program could benefit from an instructional course on the principles of healthcare policy and professional advocacy.”
Engaging resident members
The FOS healthcare policy education and leadership program may serve as an example of how educators can work with state societies to expose residents to the importance of professional advocacy. The challenges facing the U.S. healthcare delivery system are very similar to those facing local networks and educational institutions. Not only does this program appear to be successful in relaying advocacy concepts, but it may also serve as a way to impart systems-based practice competency, encouraging residents to recognize how their decisions in daily practice affect their patient populations and providing them with the tools to advocate for optimal patient care systems.
These are issues that resident orthopaedic surgeons will face as they move from academic training into practice settings. The focus of this program has been to provide residents with an open forum to discuss the issues and keep them up-to-date on AAOS efforts.
By encouraging residents to participate in the conversation and by providing them with an understanding of how they can play active roles in the solution process, state orthopaedic societies, working with residency training programs, can stimulate a life-long commitment to learning and involvement. The Florida program can serve as an example to other state societies seeking opportunities to engage residents in the effort to improve the care of orthopaedic patients.
Eric Stiefel, MD, is a PGY 5 orthopaedic resident at the University of Florida School of Medicine in Jacksonville, Florida. Brian Palumbo, MD, is a PGY 5 resident member of the class of 2012 at the University of South Florida.