title: Evaluating cost awareness education in US pediatric emergency medicine fellowships.
abstract: OBJECTIVE
  The Accreditation Council for Graduate Medical Education mandates pediatric emergency medicine (PEM) fellowships to incorporate medical care cost teaching into the curriculum; however, there are no studies evaluating cost awareness of PEM fellows. Our objectives were to evaluate cost education during fellowship and assess fellows' knowledge and attitudes regarding costs.
  
  
  METHODS
  We conducted an anonymous electronic survey of US PEM fellows in April-June 2009.
  
  
  RESULTS
  We received 161 (63%) of 253 responses. Respondents represented all 3 years of training and all regions of the United States. Asked if the Accreditation Council for Graduate Medical Education requires cost education, 35% responded no, and 44% were uncertain. More than 80% of fellows reported no formal cost education. More than 65% believed physicians should receive cost education during fellowship, and 75% felt the current amount of education is insufficient. Pediatric emergency medicine fellows showed low accuracy and considerable variability when estimating costs of tests and medications. Median fellows' estimate for a complete blood count was $50 (interquartile range, $55), where actual cost is $32. Only 23% were within 25% of the true cost. Similarly, the proportions of fellows estimating within 25% of actual cost were small for electrolytes (10%), blood culture (12%), and erythrocyte sedimentation rate (22%). The same held true for the following medications: trimethoprim-sulfamethoxazole (28%), Cefdinir (31%), and cefixime (10%). Ability to predict costs did not improve with year of training.
  
  
  CONCLUSIONS
  Pediatric emergency medicine fellows report little formal teaching on cost issues, and their ability to estimate costs is poor. However, they are receptive to more education on this important issue.
authors: Pediatric Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA. hey_june@hotmail.com
authors: June A
authors: JA
authors: Lee
authors: Lauren
authors: L
authors: Chernick
authors: Rasha
authors: R
authors: Sawaya
authors: Cindy Ganis
authors: CG
authors: Roskind
authors: Martin
authors: M
authors: Pusic
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D019937:Diagnostic Techniques and Procedures / Q000191:economics*; D004503:Education, Medical, Graduate; D004635:Emergency Medicine / Q000193:education*; D005257:Fellowships and Scholarships; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010372:Pediatrics / Q000193:education*; D011795:Surveys and Questionnaires; D014481:United States