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"A Model of Determining a Fair Market Value for Teaching Residents: Who Profits", Cullen, EJ, et al, Pediatrics 112: 40-48, 2003 Reviewed by: William G. Wilson, University of Virginia


"A Model of Determining a Fair Market Value for Teaching Residents: Who Profits", Cullen, EJ, et al, Pediatrics 112: 40-48, 2003

Reviewed by: William G. Wilson, University of Virginia

In the current economic climate of most teaching hospitals and medical schools, there are efforts to try to define the "cost" of medical education, both for undergraduate (medical) students and also for residents and fellows. This is further complicated for teaching house staff, since the institutions receive payment for having the residents, and the residents can engage in revenue-generating activities for the institution. The authors of this study, primarily intensivists and anesthesiologists, have attempted to devise a model for determining a "fair market value balance" for teaching activities in their unit. They define and derive several "return on investment" scores, favoring the CMS, the intensivists, and the residents, respectively, and compare the results in several different scenarios of increasing support for graduate medical education. They could not find a "balance point" at which these potentially competing interests were equal, although this would have been approximated if the direct medical education reimbursement were increased from their figure of 29.36% to 36%.

The authors provide an interesting analytical approach to trying to dissect the expenses and financial value related to medical education on a clinical service. While they state that their model "can be generalized to other resident teaching situations," I would be cautious to embrace this without careful study at other institutions and on other types of pediatric services. There are major differences within pediatric teaching services, and a model for PICU teaching may not translate easily to other settings.

(Well worth reading - provides a way of modeling the cost and benefit of having trainees. What are your thoughts on the "added value" of students to the clinical service? Overall, do you believe that third year medical students enhance the patient care and experience in your institution? Do you believe that training medical students adds more than 20% to the work load of the responsible MD? What percent of added work does being responsible for a medical student incur? Outpatient? Inpatient? Does your school or department have a way of quantifying the efforts of faculty to teaching that is tied to a specific dollar amount? SM)

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