ABSTRACT
OBJECTIVES: 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.
