Introduction
In 2025, more than two-thirds of new physicians graduated medical school in debt, with an average educational debt of $223,000, a 22% increase over the past decade.1 A literature review by Lin et al. found that a recurring theme in surveys across 15585 residents of differing specialties was that residents report high levels of anxiety and dissatisfaction related to their debt.2 Yet most residents have had no formal financial education by the time of graduation, despite high levels of debt and imminent increased financial obligations.3,4
A systematic review by Wesslund et al. examined differences in financial wellness curricula across different medical specialties in regard to average hours of training, financial topics and planned behavioral changes.5 It found that programs gave education sessions ranging from 1 to 12 hours in a variety of formats including lectures, small groups, a quiz show and even a dinner party. Of the 13 articles included in the review, the only one specific to emergency medicine was Shapell et al., which found that a two-day virtual webinar improved performance on a financial knowledge assessment by 21% in emergency medicine residents.6 Likewise, Rupp et al. showed that 3 hours of financial education given in a combination of virtual and in person formats to emergency medicine residents over 6-month curriculum was effective in improving scores by 12% on a financial education quiz.7
In this brief report, we describe a novel financial literacy didactic curriculum with lectures delivered by physicians, and topics curated based on the interests and needs of emergency medicine residents. Our hypothesis is that the implementation of a 5-hour, single-day, in person didactic curriculum will be an effective way to improve self-reported financial literacy in emergency medicine residents.
Methods
As physicians transition from residents to attendings, they will face a host of new financial issues. A pilot curriculum, the Transitions Conference (Transitions), was developed following a needs assessment of the residents. The curriculum consisted of five 1-hour lectures targeting common areas of financial literacy, delivered in a one-day in person didactic session to a single-center 3-year EM residency with 42 residents. Some lectures covered multiple topics (range 1-3 topics per lecture). Lecturers were all physicians with significant clinical experience who identified a special interest in financial topics. Topics as well as goals and objectives are listed in Table 1. A paper-based anonymous survey developed by an expert in medical education was given after the didactic session (Appendix). Participants consisted of attendees to emergency medicine grand rounds, which included 25 emergency medicine residents, 2 fellows, 1 attending and 3 other healthcare providers. Completion of the survey was voluntary and uncompensated. The survey queried participants on self-assessed baseline knowledge in each subject area as outlined on a 4-point Likert scale. One question prompted participants to identify if they planned to take action after attending the lecture series, and there was a free text question inquiring about future actions participants planned to take as a result of the conference. Responses were analyzed using simple descriptive statistics. This study was approved by the Wayne State University School of Medicine IRB.
Results
31 participants completed the post-didactic survey. Prior to the didactic session, the two topics that participants had the most familiarity with were budgeting and student loan repayment. 64.5% of participants reported “some” or “a lot” of prior knowledge on these two topics. The three topics with the least familiarity were independent contracting, locum tenens and contract negotiation. Greater than 75% of participants reported “little” or “none” baseline knowledge on these three topics on the survey.
The survey revealed that all participants reported learning something in at least one topic area. Nearly all respondents (96.9%) reported learning something in nine or more out of 10 topics, and over 90% reported learning something across every topic included in the curriculum.
Most participants (81%) indicated an intention to take action as a result of the curriculum. Common actions included initiating financial discussions with family members, increased engagement in contract negotiation, and obtaining disability insurance earlier than previously planned (Table 2).
Discussion
This novel pilot curriculum provided an opportunity to support financial literacy amongst EM trainees. The survey results suggest that EM residents have baseline knowledge in some financial areas, such as loan repayment and budgeting, but less so in other financial topics such as college savings, wills and trusts, life insurance and investment strategies. Many of these financial topics are generalizable to resident education in other specialties.
Our curriculum was consistent with the format implemented by programs reviewed by Wesslund et al., utilizing a lecture-based format over a few hours.5 Our data suggests that the pilot curriculum was effective in addressing financial knowledge gaps, with over 90% of participants reporting that they gained knowledge in all topics. These gains are greater than those found by Shapell et al. and Rupp et al. on their knowledge assessments, however, our results are limited by self-reported data.6,7 Importantly, it also shows that the majority of participants (81%) planned to take some specific action based on their didactic experience. This is in congruence with Rupp et al., who found that EM trainees who participated in a financial literacy curriculum were more likely to open an Individual Retirement Account (IRA), save for an emergency fund and make a written financial plan.7
As residents attain a better understanding of their finances and financial well-being, the goal is that their overall well-being will improve and rates of burnout will decrease. Cawyer et al. found that implementation of a financial wellness curriculum led to an improvement in overall wellness in obstetrics/gynecology residents.8 Walsh et al. showed that even a brief 2-hour financial education session significantly decreased the proportion of internal medicine residents who reported feelings of burnout.9 In future studies, we hope to explore the links between financial wellness, overall wellness and burnout in emergency medicine residents.
Limitations include our sample as we are a single emergency medicine residency at a downtown urban center. Residents in different specialties, community practice sites or rural areas may receive different types of financial education, so these results may not be universally generalizable. More study is also needed to determine if improved financial wellness leads to improvement in overall wellness, burnout and resilience.
Conclusions
In conclusion, our focused financial-based education curriculum increased our residents’ financial knowledge. Further studies should examine the role of improved financial knowledge in the improvement of wellbeing, resilience, and burnout among resident physicians.
Author contributions
Conceptualization: Sean McCormick (Lead), Laura Smylie (Supporting). Methodology: Sean McCormick (Supporting), Laura Smylie (Supporting). Formal Analysis: Sean McCormick (Lead). Investigation: Sean McCormick (Lead). Writing – original draft: Sean McCormick (Lead), Nicholas Pigg (Supporting), Kevin O'Hara (Supporting), Laura Smylie (Supporting). Writing – review & editing: Sean McCormick (Supporting), Nicholas Pigg (Supporting), Kevin O'Hara (Supporting), Anne Messman (Lead), Laura Smylie (Supporting). Supervision: Anne Messman (Lead).