Improving Value-Based Care Education in a Fellowship by Incorporating ACGME Competencies

Abstract

Background Most value-based care educational interventions teach knowledge of cost but fail to recognize the interrelatedness of the Accreditation Council for Graduate Medical Education (ACGME) competencies of medical knowledge, patient care, practice-based learning and improvement, and systems-based practice. Objective We analyzed the impact on clinical decision-making of an educational curriculum that incorporated the spectrum of ACGME competencies. Methods Five didactic sessions for a gynecologic oncology fellowship were modified to incorporate cost- and value-based care considerations for each clinical topic addressed. After discussion, the group of fellows identified 1 high-value and 5 low-value practices to target for improvement. The fellows then undertook a chart audit of clinical decisions occurring for patients seen in the outpatient clinics. The frequency of low- and high-value practices was compared before and after the educational intervention. Results A total of 126 patients with a cervical cancer diagnosis were seen by participants in the outpatient setting during the entire observation period. After the intervention, the occurrence of 3 identified low-value practices was reduced by 13% to 33%, demonstrating modest effect sizes (effect size ϕ = 0.2–0.3). One high-value practice (smoking cessation counseling) increased 100% after a fellow-initiated quality improvement project was undertaken. Two low-value practices, including routine surveillance imaging, remained unchanged. Conclusions Overlaying value-based concepts in didactic conference teaching resulted in measurable changes in decision-making behavior. Engaging learners in a subsequent, focused quality practice review served as a vital part of their educational experience and allowed us to assess learner competency in its practical application.

How to Implement High-Value Health Care Training in Graduate Medical Education

“…The program leaders used an existing conference structure and ''routinely and robustly'' integrated concepts of cost and value-based care into medical teaching points at all education conferences, often using a case-based approach. 10 This method reinforces that value-based health care is a part of everyday clinical decision-making. GME programs often mention lack of available time as a barrier to teaching high-value care; by incorporating this concept into the existing conference structure and each clinical topic, these program leaders solve that problem.…”

“…In this issue of Journal of Graduate Medical Education, Zanotti and colleagues describe their introduction of value-based education in a gynecologic oncology fellowship program. 10 Rather than creating a new course, program leadership of this fellowship modified regularly scheduled educational sessions to routinely incorporate considerations of costs and value-based care. These included reviewing the Choosing Wisely recommendations for their specialty.…”

Multicomponent processes to identify and prioritise low-value care in hospital settings: a scoping review

“…The majority of records (23 of 27 records) focused on the preimplementation phase of research. Four of 27 records examined evaluation, either by developing evaluation measures8 or evaluating intervention effectiveness 41 51 52…”

“…Only three included studies were designed to evaluate outcomes as opposed to developing priorities, an intervention or evaluation plan, all of which included two or three components 41 51 52. The outcomes measured related to the frequency or predicted probability of low and high value care41 51 52 and patient outcome safety event data 41.…”

“…Only three included studies were designed to evaluate outcomes as opposed to developing priorities, an intervention or evaluation plan, all of which included two or three components 41 51 52. The outcomes measured related to the frequency or predicted probability of low and high value care41 51 52 and patient outcome safety event data 41. Two studies reported findings in support of the processes41 52 and one study reported short-term somewhat positive outcomes but these were not sustained thus did not support the processes 51.…”