Non-Clinical Aspects of Medical Practice :
A Pilot Project , Longitudinal Didactic Curriculum to Enhance Preparedness in the Practice of Medicine
Kara J . Way1 , MD ; Carlos G . Romo , MD 2 ; Kinshuk Sahaya , MD 3
1
Staff Neurologist , CHI St . Vincent - Hot Springs , AR
2
Clinical / Research Neuro-oncology Fellow , John Hopkins University , Baltimore , MD
3
Adjunct-Assistant Professor of Neurology & Epilepsy , Department of Neurology , University of Arkansas for Medical Sciences , Little Rock , AR ; Neurologist and Epileptologist , Minnesota Epilepsy Group , St Paul , MN .
Objective To develop a structured , broad-based longitudinal curriculum during neurology residency training to address the non-clinical aspects of medical practice ( NCAM ).
Methods We developed and implemented an NCAM curriculum as part of the neurology residency didactic lectures . Residents were surveyed before and after the curriculum implementation .
Results The mean readiness level across all domains and all years of training demonstrated a trend of increase after the introduction of the curriculum ( 3.08 SD 0.93 vs 3.3 SD 0.606 , p = 0.46 ).
Conclusion An organized curriculum focusing on NCAM may improve the level of resident trainees ’ preparedness in practice of medicine post-residency .
Introduction
The practice of neurology , and medicine in general , is rapidly changing . Besides medical knowledge , physicians now must also have knowledge of modern practice strategies . At the same time , contemporary training may not focus on the non-clinical aspects of medical practice . Often , new physicians struggle to find balance between functioning independently , medical school debt , and personal finances . According to a recent study by AMA Insurance , only 5 % of young physicians consider themselves “ very knowledgeable ” about personal finance issues . 1 Fifty-five percent of nationwide graduating neurology residents in 2014 reported no business training during residency , and 53 % felt unprepared for practice management tasks of their future jobs . 2 These lacunae are not only restricted to business aspects of medicine but also to domains such as professionalism , leadership skills , personal wellbeing , managing student-loans , etc . 2-5 There is limited data on how residency programs teach non-clinical aspects of medical practice ( NCAM ). There have been a few initiatives in different residency specialties . 6-10 Such initiatives have had restricted scope , not infrequently limiting themselves primarily to the business of medicine .
11 , 12
We identified the lack of a structured , broadbased longitudinal curriculum to address the NCAM comprehensively . In 2016 , we instituted a structured , longitudinal curriculum that provides basic knowledge on the most important , what we called non-clinical , issues that physicians face in new practice . Physician burnout has come to the forefront lately , affecting 1 in 3 physicians in U . S . 13 Lack of work-life balance , regulatory burdens , and lack of autonomy seem to be important factors contributing towards physician burnout . 14 A well-structured program such as NCAM may contribute to fostering resilience and helping future residents develop strategies that will prevent burnout . Although our curriculum was geared primarily toward future neurologists , it can be tailored to any medical specialty .
Methods
We identified the subdomains of NCAM to be included in our longitudinal curriculum ( Tab1 ). They were identified based on The Accreditation Council for Graduate Medical Education ( ACGME ) competency measures , non-structured department faculty interviews , structured anonymous resident survey with open ended questions , other models described in literature , and our own assessment of the needs of our trainees . The curriculum was executed as a part of the preexisting , didactic lectures . These lectures were given by locally available experts in respective subject matters . The lecturers were provided a brief , summative overview of the desired scope and content but were allowed to design the lecture according to their expertise . Using established residency protocols , we ensure an ag-
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