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• W3120231617 abstract "The prospect of completing formal training from medical school, to residency, to fellowship, and to entering the workforce is what drives most of us. The innate goal that is driven home by our teachers and mentors is to learn best practices and develop a skill set that allows for the provision of a specialty level of care. The hope is we all feel well prepared by the time that new role comes to fruition and have a sense of being able to function as an independent reproductive endocrinologist. By the end of this training period, fellows will have spent years performing retrievals, monitoring cycles, scanning, operating, memorizing steroid pathways, and interpreting statistics. Yet when it comes to knowing exactly what a relative value unit is or understanding the concept of net present value, most of us would agree that many in training have a poor understanding of not only what these concepts truly mean but more importantly how they can possibly affect the day-to-day practice of medicine and care for our patients. Leaving residency and fellowship, many trainees have an idea of what they will need to learn. Mastering the foundations of reproductive medicine and required technical skills should be enough, shouldn’t it? Well, what of the new hire who joins a practice and wishes to introduce a new office surgical procedure. “What a great idea, how could anyone say no?” But the term pro forma is thrown around. “Should I know what this is? What’s the application?” Alternatively, the recently graduated fellow who is now working in a state with mandated coverage feels overwhelmed by insurance questions posed during a new patient consult. “Why do I get the feeling this couple seems to know a lot more about this than I do?” is in the thought process. These realities hit in different ways, and many may first have exposure to business and office practice issues when it comes to interviewing and looking at contracts. Others come to new revelations only a few months into the new job. Maybe the necessary skill set is a little more expansive than previously advertised. Medical education and curriculums across all levels and fields have certainly undergone an evolution. Some of this reflects shifting ideals and mindsets of different generations of physicians, and some has been a function of a changing medical landscape. As Howe and Strauss (1Howe N. Strauss W. Millennials rising: the next great generation. Vintage, New York2000Google Scholar) have postulated, the shared characteristics of certain generations are largely a function of shared experiences. Based on the definition of the millennial generation as those born between the years 1982 and 2005, the bulk of those in training and new to practice represent this generation. Millennials are characterized as being high-achieving, cooperative team players, rule followers and problem solvers (1Howe N. Strauss W. Millennials rising: the next great generation. Vintage, New York2000Google Scholar), so it is no surprise some of these themes also resonate in the medical profession. Medical school curriculums, for instance, incorporate technology in ways even those of us in training cannot imagine, and the way medicine is being taught aims to foster well-established patterns in this generation (2Eckleberry-Hunt J. Tucciarone J. The challenges and opportunities of teaching “Generation Y.”.J Grad Med Educ. 2011; 3: 458-461Crossref PubMed Google Scholar). In a large survey aiming to identify age-based and level of training–based differences in attitudes related to cost-conscious care, students and physicians alike agreed that physicians do have a responsibility to help reduce health care costs, but there were some differences (3Hunderfund A.N.L. Dyrbye L.N. Starr S.R. Mandrekar J. Tilburt J.C. George P. et al.Attitudes toward cost-conscious care among US physicians and medical students: analysis of national cross-sectional survey data by age and stage of training.BMC Med Educ. 2018; 18: 275Crossref PubMed Scopus (18) Google Scholar). Students, for example, were more likely to identify systems and organizations as playing a larger role in reducing costs. As has been previously suggested, perhaps this can be attributed to a training environment marked by record high levels of debt and an inescapable consciousness of health care costs. So it comes as no surprise that the number of MD/MBA programs continues to grow and that not only are medical school curriculums developing core topics on health care economics, but many specialties such as plastic surgery and dermatology have already integrated more business-minded topics into trainee curriculums, recognizing the deficiencies felt by new trainees in practice. A systematic literature review by our plastic surgeon colleagues sought to identify residency training programs that had some sort of business-oriented curriculum (4Zarrabi B. Burce K.K. Seal S.M. Lifchez S.D. Redett R.J. Frick K.D. et al.Business education for plastic surgeons: a systematic review, development, and implementation of a business principles curriculum in a residency program.Plast Reconstr Surg. 2017; 139: 1263-1271Crossref PubMed Scopus (18) Google Scholar). Of the 434 articles that were found in the review, 29 mentioned a formal business curriculum: four in surgical subspecialties and 25 in nonsurgical specialties (one included obstetrics and gynecology), with management/practice management being the most common topic covered. Various approaches had been attempted, including one that comprised a combination of didactics, real-time instruction in the clinic, and meetings with the “business office” (5Jones K. Lebron R.A. Mangram A. Dunn E. Practice management education during surgical residency.Am J Surg. 2008; 196: 878-882Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar). This particular program covered topics like negotiating employee agreements, malpractice insurance, and risk management; when a chart audit was performed after these didactics, resident coding compliance improved from 36% to 88% among other metrics of perceived benefit. Just as health care has evolved, so has the way in which medicine of all types is being practiced, whether it be due to revolutionary technology or to breakthroughs in fundamental knowledge. When it comes to the field of reproductive endocrinology and infertility, the advent of in vitro fertilization provided a remarkable tool to aid patients in whom little else had succeeded. From a field that started by focusing on the anatomic and endocrinologic basis of reproduction, ours is one that now includes the practice of a technology that continues to evolve. As we strive to increase access to care and navigate complex issues like coverage, the realities of our health care system necessitate we understand some of what may have traditionally been deemed as out of scope or to be acquired on a need-to-know basis. Perhaps this type of on-the-job learning is unnecessary, or causes undue stress, or is too little, too late. In a perfect world, we could all silo ourselves from the realities of health care and practice management and focus solely on patient care—but this is simply not the world we find ourselves in. We may find frustration, anxiety, and often failure when we enter the business world of medicine. Our field is a unique one, and our practices are not only multidisciplinary but diverse in terms of practice patterns, which has perhaps grown out of necessity in light of a changing field and health care system. Our training has become one of great breadth, which has allowed us to care for our patients in ways we could have never imagined. But one could argue that our training needs to encompass new horizons. Our field is fortunate to have leaders and providers who have found success in various ways, those who have learned valuable lessons and as a collective have a fund of knowledge that many of us could benefit from and could better guide the younger generation of trainees into the business of medicine. With platforms like the American Society for Reproductive Medicine and venues like the Society of Reproductive Surgeons and Society for Reproductive Endocrinology and Infertility (SRS-SREI) boot camp, the potential is there to reach trainees, and some independent efforts have already been made. The changing landscape of medicine necessitates additional guidance and training to ensure fellows start their professions with all the skills needed to be not only competent but also well-informed physicians who understand the business climate in which they practice." @default.
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• W3120231617 title "The times they are a-changin’: Isn’t it time to expand the trainee curriculum?" @default.
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