Teaching systems-based competency in anesthesiology residency: development of an education and assessment tool

The Accreditation Council for Graduate Medical Education requires programs to educate and evaluate residents in 6 competencies, including systems-based practice. We designed a survey and assessment tool to address the competency as it pertains to anesthetic drug costs in an academic center.

Residents, certified registered nurse anesthetists, and faculty were asked to complete an anesthetic drug-cost survey without relying on reference materials. After a combination of compulsory in-class didactic sessions and web-based education, the participants were asked to design an anesthetic, give example cases, and determine costs. The initial task was repeated 1 year later.

Our preintervention survey revealed that most practitioners knew very little about anesthetic drug costs, regardless of level of training or degree. All residents completed the mandatory online education tool, more than 80% attended the departmental grand rounds program, and 100% met the goal of designing an anesthetic for all cases within the preset price limit. A repeat of the cost estimate produced an improvement in cost estimates with reduction in variability (P < .05, Student unpaired t test), although estimates of volatile anesthetic and reversal agent costs did not achieve significance at the .05 level for any of the 3 cases.

Introducing a formalized teaching and assessment tool has improved our residents' understanding of anesthetic drug costs, and improved our ability to teach and assess the systems-based practice competency.