As summarized in Figure 1, the search strategy yielded 38 articles. In total, the initial search yielded 193 publications and of these, 155 were excluded. Articles were excluded because they focused on private practice management or business finance (50), had a primary focus on student debt (44), focused on nurses, pharmacists, chiropractors, or non-US physicians (30), primarily addressed moonlighting (8), were authored solely by financial advisors, bankers, or others with potential conflicts of interest (10), referred only tangentially to finance but focused on medical curricula (7), were only abstracts or posters (4), or addressed the needs of retired physicians (2). The remaining articles included six peer-reviewed reports of financial literacy curricula (Table 1), 17 reports of cross-sectional surveys, and 15 opinion pieces (Appendix Table A2).
Table 1: Characteristics and qualitative assessments of studies offering curricula
Article
|
Methodology
|
Key Findings
|
Participants
(N)
|
Strength of Findings Grade
|
Kirkpatrick Model Scores
|
Dhaliwal 2007 (Journal of General Internal Medicine) (22)
|
90-minute, faculty-led personal finance seminar; Pre-intervention financial literacy test and attitude assessment. Post-intervention assessment followed 2-10 months later by a behavior change assessment of retirement account choices.
|
Seminar attendees were more likely to switch from a default low-yield savings account to a higher-yield mutual fund investment.
|
Internal medicine residents
(52)
|
4
|
Reaction 5
Learning -
Behavior 4
Results -
|
Liebzeit 2011 (Medical Education) (45)
|
3.5-hour workshop led by the associate director of the financial aid and scholarships and a physician with expertise in personal finance. Workshop utilized a quiz show format. Post-intervention survey administered online.
|
71% felt capable of crafting a budget and improving credit and identity protections. 79% intended to develop a saving strategy.
|
Senior medical students
(117)
|
2
|
Reaction 4
Learning 3
Behavior -
Results -
|
Mizell 2014 (Journal of Surgical Research) (23)
|
18-hour curriculum spanning practice management and personal finance topics delivered by a physician who is also a certified financial planner, a surgeon with coding and reimbursement knowledge, a hospital attorney, and others. Practice management topics were delivered monthly during the daytime. Personal finance topics were delivered monthly in the evenings.
Self-assessment surveys at onset and conclusion of the curriculum. Pre- and post-tests administered after each session.
|
Participants showed increased interest, knowledge, and responsible behavior relating to personal and practice financial management.
Participant self-assessed learning overestimated actual learning as assessed by objective quiz results.
Tangents from planned lecture content led to engaging and useful conversations.
|
Surgery residents (28 involved; 16 paired responses)
|
3
|
Reaction 5
Learning 3
Behavior -
Results -
|
Meleca 2014 (Medical Student Research Journal) (46)
|
10-hour, student initiated elective curriculum spanning personal finance and medical business topics. Each 1-hour lecture was led by physicians, business owners, or financial counsellors. Pre- and post-education surveys
|
Self-assessed personal and business financial literacy nearly doubled.
90% expressed interest in a business and finance elective. 85% felt they benefited from participation. Difficult to maintain a student-led course due to leadership turnover.
|
Medical students (48)
|
2
|
Reaction 5
Learning 3
Behavior -
Results -
|
Boehnke 2018 (Journal of the American College of Radiology) (2)
|
60-minute lecture designed and delivered by physicians. Pre- and 6-month post-test surveys obtained.
|
Six-month basic financial literacy knowledge increased. 90% “definitely” or “probably” will apply acquired knowledge to their own finances.
|
Radiology residents and fellows (23 (attended lecture);
20 (completed pre- and post-tests)
|
3
|
Reaction 4
Learning 4
Behavior -
Results -
|
Bar-Or 2018 (Cureus) (28)
|
8-hour curriculum delivered in four 2-hour sessions by a business professor with expertise in physician personal finance with input from three physicians involved in GME.
Participants also received online spreadsheet templates and resources. Pre-intervention and 2-week post-intervention surveys.
|
Self-reported proactive decisions made in areas including retirement planning, investing, insurance, contracting, and debt management.
|
Cardiovascular disease, pulmonary and critical care, and infectious disease fellows
(18)
|
4
|
Reaction 5
Learning -
Behavior 3
Results -
|
Strength of Findings determined per BEME Guides 10 and 13.(43, 53)
Grade 1 No clear conclusions can be drawn. Not significant.
Grade 2 Results ambiguous, but there appears to be a trend.
Grade 3 Conclusions can probably be based on the results.
Grade 4 Results are clear and very likely to be true.
Grade 5 Results are unequivocal.
Kirkpatrick Model categories assessed on a 1 to 5-point scale, with 1 representing the least favorable outcome and 5 the most favorable impact. Dash indicates inability to assess.
Level 1 Reaction – measures participant reaction to the training (e.g., satisfaction).
Level 2 Learning – measures participant understanding of the training (e.g., change in attitude, increase in knowledge or skills).
Level 3 Behavior – measures whether participants utilized what they learned (e.g., change in behaviors)
Level 4 Results – measures whether the material had a positive impact on participants’ work and personal environments/organizations, e.g., a hospital, private practice, or household.
Most of the 38 included articles focused on GME trainees in a variety of specialty areas, although some addressed UME needs. All 38 articles (100%) reported that participants were ill-prepared to make financial decisions and 31 articles (82%) recommended that UME or GME institutions provide financial literacy education for their medical students and trainees.
As shown in Table 2, each of these articles addressed general financial planning principles and/or a variable number of finance topics, such as debt/liabilities, savings/assets, investing, budgeting, money basics (e.g., time-value, discounting, and compounding), contract negotiation, selecting and interacting with financial advisors, children’s college savings plans, insurance, retirement planning, estate planning, and taxes. The amount of topics discussed in each article varied, with two articles addressing only general financial planning,(25, 29) while four covered 10 or more topics.(16, 28, 47, 48) The most covered topic was debt (89%), followed by retirement planning (76%), budgeting (66%), savings (58%), investing (58%), and insurance (53%). Contract negotiation (11%), money basics (11%), children’s college planning (11%), and estate planning (13%) were least popular.
Table 2: Financial literacy topics included in prior curricula or in prior surveys/commentaries
Study
|
Debt / Liabilities
|
Savings / Assets
|
Investing
|
Budgeting (Income and Expenses)
|
Money Basics
|
Contract Negotiation
|
Selecting / Interacting with Advisors
|
Children’s College
|
Insurance
|
Retirement Planning
|
Estate Planning
|
Taxes
|
Financial Planning in general
|
No. of Topics Covered
|
Financial literacy topics covered in prior curricula
|
Dhaliwal 2007 (22)
|
x
|
|
|
x
|
x
|
|
|
|
x
|
x
|
|
x
|
|
6
|
Liebzeit 2011 (45)
|
x
|
x
|
x
|
x
|
|
|
|
|
x
|
|
|
x
|
|
6
|
Mizell 2014 (23)
|
x
|
|
x
|
|
|
|
x
|
|
x
|
x
|
x
|
x
|
|
7
|
Meleca 2014 (46)
|
x
|
|
x
|
|
|
|
|
|
x
|
x
|
|
x
|
|
5
|
Boehnke 2018 (2)
|
x
|
|
x
|
|
x
|
|
|
|
x
|
x
|
|
|
|
5
|
Bar-Or 2018
(28)
|
x
|
x
|
x
|
x
|
x
|
x
|
x
|
x
|
x
|
x
|
|
|
x
|
11
|
Financial literacy topics mentioned in survey-based studies
|
Teichman 2001 (7)
|
x
|
x
|
|
x
|
|
|
|
|
|
x
|
|
|
x
|
5
|
Burg 2001 (26)
|
|
x
|
x
|
|
|
|
|
|
x
|
x
|
|
|
|
4
|
Teichman 2005 (10)
|
x
|
x
|
x
|
x
|
|
|
|
|
|
x
|
|
|
x
|
6
|
Glaspy 2005 (11)
|
x
|
|
|
x
|
|
|
|
|
|
|
|
|
x
|
3
|
Brown 2010 (54)
|
x
|
|
|
x
|
|
|
|
|
|
|
|
|
x
|
3
|
Witek 2014 (25)
|
|
|
|
|
|
|
|
|
|
|
|
|
x
|
1
|
Ahmad 2017 (18)
|
x
|
x
|
x
|
x
|
|
|
|
|
|
x
|
x
|
|
x
|
7
|
Jayakumar 2017 (1)
|
x
|
x
|
x
|
|
x
|
|
|
|
|
x
|
|
|
x
|
6
|
Yoo 2017 (55)
|
x
|
|
|
|
|
|
|
|
x
|
|
x
|
|
x
|
4
|
Shappell 2018 (8)
|
x
|
x
|
x
|
x
|
|
|
|
|
x
|
x
|
|
|
|
6
|
McKillip 2018 (12)
|
x
|
|
x
|
x
|
|
|
x
|
|
x
|
x
|
|
|
|
6
|
Tevis 2018 (6)
|
x
|
x
|
x
|
x
|
|
|
|
|
|
x
|
|
|
x
|
6
|
Wong 2018 (5)
|
x
|
x
|
|
x
|
|
|
|
|
x
|
x
|
|
|
x
|
6
|
Connelly 2018 (15)
|
x
|
x
|
|
|
|
|
|
|
|
x
|
|
|
|
3
|
Mizell 2019 (48)
|
x
|
x
|
x
|
x
|
|
x
|
|
|
x
|
x
|
x
|
x
|
x
|
10
|
Jennings 2019 (27)
|
x
|
x
|
|
|
|
|
|
|
|
|
|
|
|
2
|
Adetayo 2019 (20)
|
x
|
x
|
x
|
|
|
|
x
|
|
x
|
x
|
|
|
x
|
7
|
Financial literacy topics mentioned in commentary/opinion articles
|
Greene 2002 (24)
|
x
|
|
x
|
x
|
|
|
|
|
|
x
|
|
x
|
x
|
6
|
Prabhakaran 2011 (56)
|
x
|
|
|
|
|
|
|
|
x
|
x
|
|
x
|
x
|
5
|
Thacker 2014 (17)
|
x
|
x
|
|
x
|
|
|
|
|
|
x
|
|
x
|
|
5
|
Bar-Or 2015 (29)
|
|
|
|
|
|
|
|
|
|
|
|
|
x
|
1
|
Johnson 2016 (47)
|
x
|
x
|
x
|
x
|
|
x
|
x
|
x
|
x
|
x
|
x
|
|
|
10
|
Borrelli 2017 (3)
|
x
|
x
|
x
|
x
|
|
|
|
|
|
|
|
|
x
|
5
|
Daily 2017 (16)
|
x
|
x
|
x
|
x
|
|
|
x
|
x
|
x
|
x
|
|
x
|
x
|
10
|
Mills 2018 (57)
|
x
|
|
|
x
|
|
|
x
|
x
|
x
|
x
|
|
|
|
6
|
Lundgren 2018 (4)
|
x
|
x
|
x
|
x
|
|
|
|
|
x
|
x
|
|
|
x
|
7
|
Daily 2018 (58)
|
x
|
|
x
|
x
|
|
x
|
|
|
x
|
x
|
|
|
|
6
|
Poppler 2019 (59)
|
x
|
x
|
|
x
|
x
|
|
|
|
x
|
x
|
|
|
x
|
7
|
Daily 2019 (19)
|
x
|
|
|
x
|
|
|
x
|
|
|
|
|
|
x
|
4
|
Ivy 2020 (60)
|
x
|
x
|
x
|
x
|
|
|
|
|
|
x
|
|
|
x
|
6
|
Heilman 2020 (61)
|
x
|
x
|
|
x
|
|
|
x
|
|
|
x
|
|
|
|
5
|
Moriarity 2020 (21)
|
|
|
x
|
x
|
|
|
|
|
|
x
|
|
|
x
|
4
|
No. of times topic appears in studies
|
34
|
22
|
22
|
25
|
4
|
4
|
9
|
4
|
20
|
29
|
5
|
8
|
23
|
|
Frequency of topic appearing in studies (% of 38 studies)
|
89
|
58
|
58
|
66
|
11
|
11
|
24
|
11
|
53
|
76
|
13
|
21
|
61
|
|
Six studies discussed financial literacy curricula, which were analyzed using the BEME-guided Strength of Findings approach. Table 1 summarizes the study characteristics, key findings, and Strength of Findings scores. For the Strength of Findings summary scores, two articles were graded a 2,(45, 46) two articles received a 3,(2, 23) and the remaining two articles received a 4.(22, 28) Appendix Table A3 lists the reconciled scores for each criterion of the modified Côté-Turgeon assessment tool as well as the total score for each study. In general, individual scores ranged from 2-5, and were higher for components assessing research question definition, study objectives, and participant selection. All studies had lower scores for components assessing validity and generalizability.
For the Kirkpatrick Model grades, all applicable scores were 3 or greater, with all studies reporting favorable participant reactions to personal finance literacy education (Reaction).(2, 22, 23, 28, 45, 46) Most studies also reported increased knowledge (Learning),(2, 23, 45, 46) with two studies demonstrating increased retention of knowledge in the following months.(2, 46) One of these studies found that self-assessed learning overestimated actual learning as assessed by objective quiz results.(23) Finally, two studies showed an increased utilization of knowledge (Behavior).(22, 28) However, no study revealed the impact of the curricula on participant organizations, employers, or households (Results).
The six curricula studies covered multiple topics, with one study particularly focused on retirement plans.(22) Curriculum content selection varied across the studies. For example, one study identified topics through review of the general academic literature supplemented with topics specific to GME trainees.(2) In another study, an expert financial literacy educator collated a topic list, which was then modified based on participant feedback.(28) Two studies appeared to rely on author consensus to determine content.(22, 45) The remaining two studies heavily relied on participant input.(23, 46) One of these studies found that holding sessions during protected time slots helped to increase attendance.(23)
Instructor selection also varied. Three studies utilized faculty members with a personal interest in finance but with unclear levels of expertise.(2, 22, 45) One of those studies was led by the medical school’s associate director of financial aid and scholarships.(45) The fourth utilized an academician with expertise in the field of physician personal finance.(28) The fifth and sixth used a combination of faculty and credentialed financial-services professionals.(23, 46)