Assessing Student Attitudes Regarding Cost-Consciousness in Medical Education

Abstract

Purpose: The purpose of this study was to compare attitudes regarding cost-consciousness between student populations at two medical schools in the United States and Canada.Method: We conducted a cross-sectional survey of students at Harvard Medical School and University of Toronto. We performed chi-square analyses comparing responses from the two institutions. Results:Response rates were 48% (n=162) and 45% (n=228) at Harvard and the University of Toronto, respectively. At both institutions, >96% of students agreed clinicians at all stages of training should be familiar with cost-conscious decision-making, 80% agreed physicians are responsible for discussing healthcare costs with patients, and over 80% felt they had too little education on the topic in medical school. Students differed in opinions about the extent to which patients should inquire about costs, with students at Harvard more likely to endorse this opinion compared with those from Toronto (51% vs 28%, respectively), and differed over whether cost-consciousness led to rationing of healthcare (Harvard 30% vs Toronto 51%). Fewer than 10% of all students expressed concerns that incorporating costs into care was unethical. Overall, 85% of students from both countries would like more formal teaching on this topic. Discussion: Students from both schools strongly endorsed a need to learn more about cost-conscious decisionmaking. Findings suggest students in both systems can benefit from learning similar core concepts related to highvalue, cost-conscious care, and teaching in this topic can be customized to reflect specific differences in expectations and practices in the two healthcare systems. Methods Study populationThe study population consisted of second-and fourth-year medical students at Harvard Medical School and the University of Toronto. We chose these two populations to reflect the level of training at the end of the pre-clinical and clinical years of medical school training, respectively. Survey instrumentWe developed a 25-item electronic survey instrument using the Qualtrics © (Qualtrics, Provo, Utah) survey software platform to assess knowledge and attitudes regarding the role of cost-consciousness in medical education. (Qualtrics, 2013) The domains covered by the survey included: 1) demographic information, 2) formal and informal training in costs of care, 3) responsibility for cost-conscious decision making, 4) the role of cost-consciousness in specific types of clinical scenarios, 5) sources of cost-conscious knowledge, 6) attitudes regarding costs of care and cost-conscious decision making, 7) cost-conscious curriculum at their medical school. We hypothesized that attitudes among medical students may be influenced by stage of training, professional goals and prior experiences. With this

National cross-sectional study on cost consciousness, cost accuracy, and national medical waste reduction initiative knowledge among pediatric hospitalists in the United States

“…Nearly all respondents support early introduction of hospital-specific costs and education on national medical waste reduction Initiatives during medical school or residency, a finding that supports previous calls to introduce these topics earlier in training [ 15 , 24 , 29 ]. Previous studies have shown an association between higher cost consciousness and longer clinical work experience [ 14 ], but studies have not looked at cost accuracy in relation to clinical work experience.…”

Perspectives On Health Care Cost-Consciousness among Medical Students and Physicians

“…A cross-sectional survey of students by Marisa Leon-Carlyle, et al 11 at Harvard Medical School and University of Toronto, at both institutions, >96% of students agreed clinicians at all stages of training should be familiar with cost-conscious decision-making, 80% agreed physicians are responsible for discussing healthcare costs with patients, and over 80% felt they had too little education on the topic in medical school. Overall, 85% of students from both countries would like more formal teaching on this topic.…”

“…The Study tool consisted of self-administered validated questionnaire to elicit sources of knowledge on health care costs, health care responsibility, cost conscious decision making and curriculum. The questionnaire was developed based on the study done by Leon-Carlyle M et al 11 by the authors. A pilot survey was done to a separate group of 30 medical students; the questionnaire was validated based on the preliminary results and suggestions.…”