CREATING COST CONSCIOUS RESIDENTS IN OBSTETRICS AND GYNECOLOGY: A RANDOMISED CONTROLLED TRIAL

Abstract

Objectives Residents have a professional obligation to the stewardship of healthcare resources yet there is a paucity of research onhow to improve their cost-awareness. Rising health care expenditure has highlighted a critical need to improve education in this competency. This study aims to test if an educational module can teach residents to make cost-conscious management plans and reduce health care spending. Methods All Canadian Obstetrics and Gynecology residents in 2017 were eligible for this randomised controlled trial. The study was administered online via REDCap. Interested residents were enrolled, stratified by level of training and block randomised. Residents completed a survey to determine their management of four obstetrical scenarios. The intervention group reviewed an educational module on cost-effective ordering prior to completing the survey; the control group had the option to review it after. The primary outcome was mean total expenditure as calculated from the survey. Student's t-test was used to compare the mean total expenditure between the two groups. Results 85 residents were enrolled, 63 residents completed study requirements (33 control and 30 intervention). Mean total expenditure was $291.03 CAD (95% confidence interval [CI] 259.38-322.68) versus $192.98 CAD (95% CI 170.67-215.29) in the control and intervention groups respectively, corresponding to a 33.69% or $98.05 CAD (p=0.0001) reduction in total expenditure. Conclusions This educational module decreased expenditure by Canadian Obstetrics and Gynecology residents in the management of hypothetical obstetrical cases. This introduces a potential curriculum innovation to improve resident education in judicious use of healthcare resources.