Current and Optimal Training in High-Value Care in the Internal Medicine Clerkship: A National Curricular Needs Assessment

Cayea, Danelle; Tartaglia, Kim; Pahwa, Amit; Harrell, Heather; Shaheen, Amy W.; Lang, Valerie J.

doi:10.1097/acm.0000000000002192

Cited by 22 publications

(25 citation statements)

References 13 publications

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“…Given the limited curriculum time and resources, implementation of this HVC curriculum at other schools is feasible. The use of virtual patients and small group learning as the main educational methods promotes active learning and limits the need for faculty time, which was cited as a barrier to HVC curriculum implementation by clerkship directors [8].…”

Section: Discussionmentioning

confidence: 99%

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Effect of a high value care curriculum on standardized patient exam in the Core Clerkship in Internal Medicine

et al. 2020

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Background With almost 20% unnecessary spending on healthcare, there has been increasing interest in high value care defined as the best care for the patient, with the optimal result for the circumstances, delivered at the right price. The American Association of Medical Colleges recommend that medical students are proficient in concepts of cost-effective clinical practice by graduation, thus leading to curricula on high value care. However little is published on the effectiveness of these curricula on medical students’ ability to practice high value care. Methods In addition to the standard curriculum, the intervention group received two classroom sessions and three virtual patients focused on the concepts of high value care. The primary outcome was number of tests and charges for tests on standardized patients. Results 136 students enrolled in the Core Clerkship in Internal Medicine and 70 completed the high value care curriculum. There were no significant differences in ordering of appropriate tests (3.1 vs. 3.2 tests/students, p = 0.55) and inappropriate tests (1.8 vs. 2.2, p = 0.13) between the intervention and control. Students in the intervention group had significantly lower median Medicare charges ($287.59 vs. $500.86, p = 0.04) and felt their education in high value care was appropriate (81% vs. 56%, p = 0.02). Conclusions This is the first study to describe the impact of a high value care curriculum on medical students’ ordering practices. While number of inappropriate tests was not significantly different, students in the intervention group refrained from ordering expensive tests.

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Section: Discussionmentioning

confidence: 99%

“…Additionally, most of the HVC curricula developed for clinical clerkships do not have an assessment [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Effect of a high value care curriculum on standardized patient exam in the Core Clerkship in Internal Medicine

et al. 2020

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“…The use of virtual patients and small group learning as the main educational methods promotes active learning and limits the need for faculty time, which was cited as a barrier to HVC curriculum implementation by clerkship directors. (8) Students in high intensity regions are more likely to display low-value behaviors thus high value care…”

Section: Discussionmentioning

confidence: 99%

“…(6) Yet, students and internal medicine clerkship directors feel education in these concepts is inadequate, and only 30% of internal medicine clerkships have a formal HVC curriculum. (7,8) Additionally, most of the HVC curricula developed for clinical clerkships do not have an assessment. (8)(9)(10) This mismatch between assessments and curricula as well as the paucity of effective HVC curriculum still needs to be addressed.…”

Section: Introductionmentioning

confidence: 99%

“…(7,8) Additionally, most of the HVC curricula developed for clinical clerkships do not have an assessment. (8)(9)(10) This mismatch between assessments and curricula as well as the paucity of effective HVC curriculum still needs to be addressed. We aimed to study the effectiveness of a HVC curriculum in the Core Clerkship in Internal Medicine (IM Clerkship) using a randomized control trial and an outcome directly controlled by medical students.…”

Section: Introductionmentioning

confidence: 99%

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Effect of a High Value Care Curriculum on Standardized Patient Exam in the Core Clerkship in Internal Medicine

Pahwa

Eaton

Apfel

et al. 2020

Preprint

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Background: With almost 20% unnecessary spending on healthcare, there has been increasing interest in high value care defined as the best care for the patient, with the optimal result for the circumstances, delivered at the right price. The American Association of Medical Colleges recommend that medical students are proficient in concepts of cost-effective clinical practice by graduation, thus leading to curricula on high value care. However little is published on the effectiveness of these curricula on medical students’ ability to practice high value care.Methods: In addition to the standard curriculum, the intervention group received two classroom sessions and three virtual patients focused on the concepts of high value care. The primary outcome was number of tests and charges for tests on standardized patients.Results: 136 students enrolled in the Core Clerkship in Internal Medicine and 70 completed the high value care curriculum. There were no significant differences in ordering of appropriate tests (3.1 vs. 3.2 tests/students, p = 0.55) and inappropriate tests (1.8 vs. 2.2, p = 0.13) between the intervention and control. Students in the intervention group had significantly lower median Medicare charges ($287.59 vs. $500.86, p = 0.04) and felt their education in high value care was appropriate (81% vs. 56%, p = 0.02).Conclusions: This is the first study to describe the impact of a high value care curriculum on medical students’ ordering practices. While number of inappropriate tests was not significantly different, students in the intervention group refrained from ordering expensive tests.

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Toward a Pellegrino-inspired theory of value in health care

DeCamp

2019

Theor Med Bioeth

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Current and Optimal Training in High-Value Care in the Internal Medicine Clerkship: A National Curricular Needs Assessment

Abstract: Internal medicine clerkship directors reported that HVC is insufficiently taught and assessed in medical school, despite relevance to practice. Developing generalizable curricular materials, faculty development, and dedicated curricular time may enhance HVC education.

Cited by 22 publications

References 13 publications

Effect of a high value care curriculum on standardized patient exam in the Core Clerkship in Internal Medicine

Effect of a high value care curriculum on standardized patient exam in the Core Clerkship in Internal Medicine

Effect of a High Value Care Curriculum on Standardized Patient Exam in the Core Clerkship in Internal Medicine

Toward a Pellegrino-inspired theory of value in health care

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