The development of resident "report cards" in the context of managed care education

This article describes the development of residents' report cards as one co mponent of a curriculum on physician profiling for primary care residents. Thirty-two first-year residents matriculating into family practice, interna l medicine, pediatrics, and obstetrics-gynecology residency programs in 199 8 were profiled. The patient information in the report cards was limited to data on a panel of Medicaid patients initially seen in the resident ambula tory care clinics. All subsequent patient care for that population was also included. The method was multi-step and complex, involving hospital billin g personnel and cooperation with a managed care partner. A three-session ed ucational program was developed to introduce the concept of physician profi ling. The first session consisted of a panel discussion on managed care. Th e second session was devoted to a discussion of hypothetical physician prof iles with inappropriate length of stays, days/1,000, low numbers of office visits combined with high urgent-care use, and high outpatient services uti lization. Small groups of residents participated in a problem-identificatio n process as if they were members of a group practice. Residents identified problems in the reports and made suggestions for behavioral changes. A fin al session presented residents with their own personal report cards. Reside nts were surveyed both at the beginning of their first year and before and after the educational intervention on profiling. Resident attitudes, which were negative toward managed care at the outset, became generally more posi tive. Comparisons of pre-test and post-test means on the five-point Likert scale, using a paired-samples t-test, revealed significant changes in the r esidents' attitudes overall.