Supplement 2 Graph : Median level of readiness across tested sub-domains of NCAM KW = 15.896 , p = 0.1450
tation survey was completed by 7 ( 63.6 %), and post-implementation survey was completed by 5 ( 45.5 %). Results are presented in supplement 1 , graph 1 . The mean readiness level across all domains and all years of training demonstrated a nonsignificant increase after the introduction of the curriculum ( 3.08 SD 0.93 vs 3.3 SD 0.606 , p = 0.46 ). Before the introduction of the curriculum , the various subdomains demonstrated statistically similar readiness levels . Exceptions included Contract Negotiations and Business Models ( which demonstrated significantly lower median readiness levels than Choosing a Mentor , Evidence Based Medicine , and Communication in the Workplace , respectively ( Graph 1 ). Post implementation , no significant difference was found in the readiness levels of the different subdomains . After introduction of the curriculum , there was a statistically nonsignificant trend towards increase in readiness level across
This pilot study was aimed at introducing a structured , longitudinal curriculum focused towards aspects of practice of medicine that are not routinely or usually covered during residency training consistently across the country . most subdomains and along the year of training ( Supplement 2 ). Within each subdomain , too , there was a similar trend towards increase in the readiness level after introduction of the curriculum ( Supplement 1 ).
Discussion
This pilot study was aimed at introducing a structured , longitudinal curriculum focused on aspects of practice of medicine that are not routinely or usually covered during residency training consistently across the country . With the recent emphasis on physician burnout , especially in neurology , it is imperative that our trainees are equipped with tools for achieving a work-life balance in practice . 14 , 16 For the ease of communication , we chose the phrase non-clinical to describe these aspects , but they might not be entirely non-clinical .
The confidence level , and perhaps the knowledge level , of graduating residents in issues such as managing finances , starting a practice , and contract negotiation may not be as high as it should be . Several workers have tried to introduce various curriculum of somewhat restricted scope , commonly but not exclusively focusing upon business of medicine , with variable results . 6 , 8 , 10-12 We designed and implemented the curriculum change with broader scope , focused on practice in “ real life .” We identified the subdomains of interest by various strategies including , but not limited to , the survey of the residents , thus also incorporating the felt-need of the trainees . Before the implementation of the curriculum , most of the different subdomains included had similar perceived levels of readiness . At the same time , residents felt significantly lower readiness levels in a few subdomains ( Business Models of Practice and Contract Negotiations ) not routinely taught during residency . Although we were not able to demonstrate a statistically significant improvement in readiness levels by the introduction of our curriculum , there appeared to be a trend towards improvement ( Graph 1 , Supplement 2 ). The trend was seen across several subdomains . As might be expected , there was also an increase in aggregate readiness level with increasing level of training ( Supplement 3 ). Our curriculum demonstrated a trend towards improvement in this aggregate readiness level in each level of training ( Supplement 3 ).
Our project also has some limitations . This is a pilot project with a very small sample size limited to only one residency program . Our response rate was also low . As the surveys were anonymous , and not all residents participated in both the surveys , a true repeated measure analysis was not feasible . One may expect the level of readiness to be proportional to the level of training . This was also seen in the preimplementation survey ; hence , the increased readiness levels may simply be reflective of the general effect of residency training . At the same time , we saw a trend towards increase in all three levels of training ; hence , the curriculum might have had a real impact on the level of readiness . We also did not have a control group . A bias may be introduced by the implementation of the curriculum itself as it may have led the residents to pay more attention to the NCAM . The survey instruments were subjective responses by the participating residents and no objective measures of improvement in skill were used . Such objective measures are neither widely available , nor easy to test .
To summarize , it seems that introduction of a structured , longitudinal curriculum may help in improving the readiness of resident trainees , but further research is warranted in designing such comprehensive curriculum , its implementation and ultimate effect on comprehensive practice
32 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY VOLUME 115