Assessing residents' readiness for working in a managed care environment

Purpose. A the pilot study to assess the state of residents' training for practice in a managed care environment. Method. In May and June 1996, all 178 residents at the University of Kentucky College of Medicine in six programs were approached to participate in the study. An instrument was created to assess the residents' knowledge of, attitudes toward, and exposure to managed care, as well as their perceptions of their residency experience. Attitudinal items were measured using a five-point Likert scale (1 = strongly agree, 5 = strongly disagree), as were the assessments of experience (1 = excellent, 5 = poor). Bivariate statistics were computed between the number of correct responses to the knowledge questions and both the year of training and reported exposure to managed care. The relationship between exposure and knowledge was analyzed using a two-tailed t-test. A Pearson product-moment correlation was computed between residents' knowledge and year of training. Results. In all, 140 (79%) residents participated, 76% of whom were men. Seventy-three percent of the residents rated their experiences as fair or poor; the mean rating across all the residents was 3.8 (SD, 0.8). Among those reporting some exposure, attitudes toward the effectiveness of their exposure generally ranged from neutral to negative. Across all the residents, the mean number of correct responses to the five knowledge questions was 3.2 (SD, 1.1). No statistically significant relationship was found between year of training and the number of correct responses. The residents who reported some exposure to managed care had a significantly higher mean number of correct responses than did those with no reported exposure (3.4, SD, 1.1, vs 2.8, SD, 1.3, p = .04). Conclusion. The residents reported limited exposure to managed care and that their training experience did not prepare them for working in managed care; this was confirmed (in a limited way) by the responses to the knowledge questions. As managed care expands in the United States, the systematic incorporation of managed care instruction into training is necessary to appropriately prepare residents for future practice.