Improving Education on Cost-Effective Care in Neurosurgery: A Personalized, Web-Based Intervention for Residents

From the 2022 HVPA National Conference

Debraj Mukherjee M.D., M.P.H. (Johns Hopkins University School of Medicine), Adham Khalafallah M.D. (University of Miami), Sachiv Chakravarti, Kyle Cicalese B.S., B.A., Jose Porras M.D., Adrian Jimenez B.S.      


While training residents in the socioeconomics aspects of neurosurgery has become a priority for residency programs across the country, programs dependent on in-person participation are difficult to implement given resident schedules and the COVID-19 pandemic. 


The goal of this study was to assess the efficacy of a web-based, socioeconomic educational program for neurosurgery residents.


Coding and billing data from 13 neurosurgical procedures were organized into 5 interactive modules sent to residents weekly. Residents also completed a 20-question pre- and post-intervention examination based on 4 distinct educational domains as described by the Accreditation Council for Graduate Medical Education (ACGME)’s Neurological Surgery Milestones: Billing code information, Procedure-specific concepts, Material costs, and Operating room procedures.


The pre-intervention survey was completed by 23/27 residents (85.2%) with a mean score of 9.55. The post-intervention survey was completed by 17/27 residents (63.0%) with a mean score of 9.97. Overall, there was no statistically significant difference between correct pre- vs. post-responses assessing residents’ knowledge of billing codes (3.96 vs 4.41, p=0.33), procedure protocol (3.09 vs 3.53, p=0.11), material (0.96 vs 0.65, p=0.75), or operating room protocols (1.55 vs 1.06, p=0.61). However, respondents’ accuracy for code-related question #1 (“What is a CPT code?”) and procedure-specific questions #8 (“For a supratentorial craniotomy for subdural hematoma evacuation, what is the average length of the procedure?”) and #9 (“For a supratentorial craniotomy for tumor resection, what is the average physician charge?”) increased significantly following the intervention (p=0.0041, p=0.016 and p=0.0061, respectively). Importantly, these questions were among the most replicated during the 5-week intervention.


Our program demonstrates that increased access to billing and coding data can serve as a decentralized, virtual model of education for the socioeconomics of neurosurgery. 

Clinical Implications

Our experience demonstrates the potential of self-driven learning modalities that can easily be integrated into existing resident workflows.

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