Presentation Authors: Ashley W. Johnston*, Eugene B. Cone, Durham, NC, Jonathan Bergman, Tannaz Moin, Arlene Fink, Los Angeles, CA, B. Price Kerfoot, Boston, MA, Charles D. Scales, Durham, NC
Introduction: Health care researchers and policy-makers are increasingly applying behavioral incentives. Well-designed incentive structures can help individuals overcome barriers to engagement in a variety of activities, including education. Quality improvement (QI) education is required for urology residents, yet engagement may suffer from a perceived lack of learner interest. Our objective was to compare resident participation in a urology-specific QI curriculum with two difference behavioral incentives: team-based competition versus individual incentives.
Methods: We conducted a multicenter cluster randomized trial of ACGME-accredited urology residency programs stratified by size. Programs were randomized to either a team-based competition or an individual incentive environment. In both, residents participated in an identical QI program on QstreamÂ®, a web-based, mobile-device-compatible platform. Biweekly for 12 weeks, residents were emailed a link to the platform introducing 20 clinical-scenario-based questions. In the team-based competition environment, weekly leader boards displayed team standings. In the individual incentive arm, residents were eligible for a weekly loss-framed incentive that required the winner be current on attempted questions. Our primary outcome was percentage of questions attempted. Secondary outcomes included participation, defined as attempt of at least 1 question, and mastery, correctly answering a question twice-in-a-row.
Results: We enrolled 453 residents from 36 accredited urology residency programs. Significantly more residents participated in the team-based competition than the individual-incentive environment (71% vs. 58%, p=0.005). Residents in the team-based competition not only attempted a greater percentage of questions than those in the individual incentive environment (60% vs. 44%, p < 0.001), but also mastered a greater percentage of questions (24% vs. 16%, p < 0.001). Almost half of residents in the team-based competition, 45%, answered every question versus only one third of those in the individual-incentive arm, 33% (p=0.01).
Conclusions: The inclusion of behavioral incentives in medical education enhanced resident engagement. Specifically, learner participation and knowledge mastery in a QI curriculum increased with team-based competition. Additionally, we demonstrated the feasibility of national implementation of a specialty-specific QI curriculum. Further studies are needed to investigate the effects of behavioral interventions in other medical education contexts.
Source of Funding: Society of Academic Urologists