title: Cost-aware care: critical core competency.
abstract: OBJECTIVE
  Resident core competence can be improved by learning to accurately estimate the costs of postoperative complications.
  
  
  METHODS
  Prospective, institutional review board-approved study. In step 1, residents were provided 3 clinical vignettes detailing specific treatment measures for postsurgical complications and asked to assign total cost estimates for the treatment for each vignette; in step 2 they were given a pocket-sized cost card listing hospital costs, and in step 3, after 2 weeks, they were retested using the same clinical vignettes as in step 1.
  
  
  METHODS
  University of Connecticut, Farmington, and the Yale University School of Medicine, New Haven.
  
  
  METHODS
  Fifty-three general surgery residents.
  
  
  METHODS
  Cost estimates for steps 1 and 3 were compared using the paired t test and analysis of variance to examine whether there is a difference between the baseline cost estimates and the actual cost; whether introduction of the cost card improves performance; and whether responses correlate to postgraduate year level or to the clinical vignette.
  
  
  RESULTS
  There was a statistically significant difference between the baseline cost estimates (before introduction of the cost card) and the actual cost of the treatment (P = .03). Introduction of the cost card resulted in a statistically significant improvement between the cost estimates before and after the intervention (P = .002), with a drop in average percentage error by 35% (range, 32%-38%). Level of postgraduate training or type of test vignette (at analysis of variance) did not seem to be a significant factor.
  
  
  CONCLUSIONS
  There is a lack of awareness among surgical residents of the cost of treatment of postoperative complications. Introduction of a simple educational tool such as a cost card measurably improves their overall understanding of the cost of care and can be easily incorporated into the residency curriculum.
authors: Division of Plastic Surgery and Departments of Medicine and Surgery, University of Connecticut School of Medicine, Farmington, CT 06030-1601, USA. Chandawarkar@uchc.edu
authors: Rajiv Y
authors: RY
authors: Chandawarkar
authors: Shiv
authors: S
authors: Taylor
authors: Peter
authors: P
authors: Abrams
authors: Andrew
authors: A
authors: Duffy
authors: Anthony
authors: A
authors: Voytovich
authors: Walter E
authors: WE
authors: Longo
authors: Robert A
authors: RA
authors: Kozol
mesh_terms: D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003082:Colectomy / Q000009:adverse effects*; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D013502:General Surgery / Q000193:education*; D017048:Health Care Costs; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics* / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies