‘But what if you miss something …?’: factors that influence medical student consideration of cost in decision making

Abstract

Context Cost-conscious care is critical for healthcare sustainability but evidence suggests that most doctors do not consider cost in their clinical decision making. A critical step in changing this is understanding the barriers to encouraging behaviours and attitudes related to cost-conscious care. We therefore conducted a qualitative study to address the research question: what factors influence consideration of cost in emergency medicine (ED) clinical decision making? Methods This was a qualitative focus group study using patient vignettes to explore attitudes towards cost-conscious clinical decision making. Participants were Year 4 and Year 5 medical students from Singapore, a country with a fee-for-service healthcare system. After a data-driven initial data analysis, and to make sense of a multitude of factors impacting on cost conscious care, we selected Fishbein’s integrative model of behavioural prediction to underpin secondary data analysis. Results Via four focus groups with 21 participants, we identified five main themes relevant to the integrative model of behavioural prediction. These were: attitudes towards considering cost when managing a patient (e.g., “better safe than sorry”); normative beliefs (e.g., doing what others do, perceptions of patient wishes); efficacy beliefs (e.g., no authority to take decisions or challenge); skills and knowledge (e.g., little knowledge of costs), and environmental constraints (e.g., the nature of the healthcare system). Discussion Medical students do not consider cost in their clinical decision making due to numerous factors, of which lack of knowledge of costs is but one. While some of the factors identified reflect those found in previous studies with residents and fully-trained staff, and in other contexts, theory driven analysis added value in that it facilitated a richer exploration of why students do not consider cost in clinical decision making. Our findings provide insight to inform how best to engage and empower educators and learners in teaching and learning about cost-conscious care.

Differences in high school students' mathematical representation ability in homogeneous classes: Which is better?

“…The group work model has the disadvantage that students with high cognitive abilities tend to dominate so that freedom of imagination is low because the majority will only depend on them (Hine et al, 2022). Other students also tend to adapt to the concepts proposed so that other views on the concepts they face are minimal and they also worry when they differ from their colleagues (Tan et al, 2023). This is allegedly the cause of female students having high mathematical representation in the aspect of precision and accuracy, but having a low level in the aspect of imagining or creating alternative illustrations in solving the physics problems they face (Anggraini et al, 2023;Fahuzan & Santosa, 2018;Supratman et al, 2023).…”

The Value of Role Modeling in Value Conscious Medicine

“…Since learners follow the norms of what they see, role models who prioritize VCM are critical. 3 If students and early-career physicians do not see their role models (i.e., more senior physicians) factoring cost into clinical decision making, they will not have the incentive to do so themselves—as VCM is a culture. 4 Early-career physicians may not even perceive their role as being concerned with costs, seeing this as more of an administrative concern than a clinical one.…”