“Comments on: Business Education for Plastic Surgeons

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Background: Rising healthcare costs, decreasing reimbursement rates, and changes in American healthcare are forcing physicians to become increasingly business-minded. Both academic and private plastic surgeons can benefit from being educated in business principles. We conducted a systematic review to identify existing business curricula and integrated a business principles curriculum into residency training. Methods: We anonymously surveyed our department regarding perceived importance of business principles and performed a systematic literature review from 1993-2013 using PubMed and Embase to identify residency training programs that had designed/implemented business curricula. Subsequently, we implemented a formal, quarterly business curriculum. Results: Thirty-two (88.9%) of 36 physicians (76.6% response rate) stated business principles are either "pretty..." or "very important" to being a doctor. Only 36% of faculty and 41% of trainees had previous business instruction. We identified 434 articles in the systematic review: 29 documented formal business curricula. Twelve topics were addressed with practice management/administration (n=22) and systems-based practice (n=6) being the most common. Four articles were from surgical specialties: otolaryngology (n=1), general surgery (n=2), and combined general surgery/plastic surgery (n=1). Teaching formats included lectures and self-directed learning modules; outcomes and participant satisfaction were inconsistently reported. From August 2013-June 2015, we held eight business principles sessions. Post-session surveys demonstrated moderately-to-extremely satisfied responses in ≥75% of resident/fellow respondents (n=13, response rate=48.1%) and faculty (n=9, response rate=45.0%). Discussion: Business principles can be integrated into residency training programs. Having speakers familiar with the physician audience and a session coordinator is vital to program success.
The current Accreditation Council for Graduate Medical Education guidelines separate residents' education into six core competencies or subjects. The authors address the least intuitive of these, systems-based practice. In systems-based practice, educators and residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Plastic surgery is a specialty that is intimately involved with the economics, coordination of care, and real-life experience of resource allocation. It should be avant-garde in the development of a systems-based educational experience and be in the forefront in creating an appropriate and well-thought-out teaching agenda for graduate medical education. The authors explain and expand this definition to include objectives for plastic surgery training, programs, and individual learning goals. A series of didactic lectures, small group discussions, and grand round presentations are suggested to fulfill and facilitate the educational objectives. A potential time allotment and method of objective and subjective evaluations are offered.