Teaching and Evaluating High-Value Care Through a Novel Case-Based Morning Report Curriculum

Abstract

Introduction: It's the responsibility of medical educators to train residents to be responsible stewards of finite health care resources. Thus, we developed an interactive morning report curriculum that focuses on high-value care (HVC) decision making using real-world cases. In addition, we developed a novel evaluation tool to assess residents' application of cost-conscious care principles through the use of an HVC scoring algorithm. Methods: For each HVC morning report session, a resident presents a case that they encountered recently. Prior to their presentation, the resident reviews guidelines and meets with a physician with expertise in the field to determine the best practice for the case with regard to what imaging, laboratory studies, procedures, and/or consultations were necessary to arrive at the correct diagnosis and treatment course. The resident presents the case while indicating what they would order based on the information provided. Following the session, an HVC score is determined for each participant by awarding points for appropriate, cost-conscious utilization of resources. Points are deducted for unnecessary overuse of health care services and inappropriate underuse of services. Results: Over the course of the 2014-2015 academic year 34 internal medicine residents participated in at least one HVC Morning Report session. The number of participants reporting that their knowledge of health care costs was poor, dropped from 70% on the precurriculum survey to 29% of the postcurriculum survey. Discussion: The HVC Morning Report Curriculum was successful in improving resident knowledge of HVC and comfort with cost effective decision making. Due to the real-world nature of the cases presented, there was a great deal of variability in the complexity of the cases presented by residents. Future directions might include developing a collection of high-yield cases for increased standardization of the learning.

Applying High-Value Care Principles in a Pediatric Case: A Workshop for Health Professions Students

“…In order to prepare medical students to apply HVC concepts when making medical decisions for pediatric patients, we developed an interactive workshop that reviews concepts of HVC, including the Choosing Wisely lists in pediatrics and encouraged thinking of downstream effects of medical decisions. Overall, this workshop has been well received by participants and similar to other studies, [25][26][27][28] participants reported increased confidence and self-assessed competence in providing high-value, cost-conscious care. Students reported that the curriculum improved their knowledge of HVC by pushing them to understand how an intervention changes management and to think about cost and harm.…”

“…Students reported that the curriculum improved their knowledge of HVC by pushing them to understand how an intervention changes management and to think about cost and harm. However, unlike previously published interventions, [25][26][27] our learners were not told that the case discussion was based in HVC concepts which made it more likely that students gave their initial diagnostic plan unbiased by the idea of HVC. Because the facilitator then prompted them to explain why they were asking for a test or intervention and if and how that changed management, this allowed the students to make new connections between their current thinking and HVC.…”

“…For this reason, teaching HVC principles is crucial for students as they will be the future drivers in health care. While a few studies have implemented curricula for residents [23][24][25][26][27] and medical students in internal medicine, 28,29 there are no studies to our knowledge, including on MedEdPORTAL, examining the effect of a pediatricbased curriculum on medical students alone. Unlike existing workshops, 23,29 our session was delivered in a single 1-hour session, making it efficient and easily incorporated into an existing conference schedule.…”

Development and Evaluation of High-Value Pediatrics: A High-Value Care Pediatric Resident Curriculum

“…Necessary educational resources are available through journal sections on value, 17,18 Choosing Wisely resources, 19 and various other HVC curricula. [20][21][22][23] Despite these resources, data reveal that only 10% of pediatric program directors and 15% of internal medicine residency programs report having a formal curriculum on HVC. 24,25 In a survey of pediatric residency programs, respondents identified the largest barrier to HVC as a lack of cost transparency.…”

Teaching High-Value Care in Pediatrics: A National Survey of Current Practices and Guide for Future Curriculum Development

“…12 In the past decade, we have made progress establishing needed educational resources around HVC with the introduction of journal sections on value, 13,14 the Choosing Wisely campaign, 15 and HVC curricula. [16][17][18][19] Despite this increase in resources, there remains a significant gap in uptake. Several national surveys have found low rates of formal HVC education in internal medicine residency programs.…”