Teaching Cost-Effective Diagnostic Test Use to Medical Students

Williams, Sankey V.; Eisenberg, John M.; Kitz, D S; Carroll, Jean Gayton; Beck, L.; Rubin, Seth M.; Ruff, George E.

doi:10.1097/00005650-198406000-00004

Cited by 14 publications

(8 citation statements)

References 12 publications

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“…Six studies explored medical students' attitudes towards principles of managed care and cost containment [9-14]. Students' attitudes were mixed.…”

Section: Resultsmentioning

confidence: 99%

“…Lazarus et al (1998) and O'Connell et al (2004) found positive changes in attitudes post-intervention [9,13] while Williams et al (1984) found no change in attitudes towards managed care following a cost containment educational programme [14]. O'Connell et al (2004) examined medical students' attitudes and knowledge about Managed Care Organisations and assessed the effects of a teaching programme that spanned 4 years [13].…”

Section: Resultsmentioning

confidence: 99%

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Attitudes of medical students to medical leadership and management: a systematic review to inform curriculum development

et al. 2011

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BackgroundThere is a growing acknowledgement that doctors need to develop leadership and management competences to become more actively involved in the planning, delivery and transformation of patient services. We undertook a systematic review of what is known concerning the knowledge, skills and attitudes of medical students regarding leadership and management. Here we report the results pertaining to the attitudes of students to provide evidence to inform curriculum development in this developing field of medical education.MethodsWe searched major electronic databases and citation indexes within the disciplines of medicine, education, social science and management. We undertook hand searching of major journals, and reference and citation tracking. We accessed websites of UK medical institutions and contacted individuals working within the field.Results26 studies were included. Most were conducted in the USA, using mainly quantitative methods. We used inductive analysis of the topics addressed by each study to identity five main content areas: Quality Improvement; Managed Care, Use of Resources and Costs; General Leadership and Management; Role of the Doctor, and Patient Safety. Students have positive attitudes to clinical practice guidelines, quality improvement techniques and multidisciplinary teamwork, but mixed attitudes to managed care, cost containment and medical error. Education interventions had variable effects on students' attitudes. Medical students perceive a need for leadership and management education but identified lack of curriculum time and disinterest in some activities as potential barriers to implementation.ConclusionsThe findings from our review may reflect the relatively little emphasis given to leadership and management in medical curricula. However, students recognise a need to develop leadership and management competences. Although further work needs to be undertaken, using rigorous methods, to identify the most effective and cost-effective curriculum innovations, this review offers the only currently available summary of work examining the attitudes of students to this important area of development for future doctors.

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“…Six studies explored medical students' attitudes towards principles of managed care and cost containment [9-14]. Students' attitudes were mixed.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Attitudes of medical students to medical leadership and management: a systematic review to inform curriculum development

et al. 2011

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“…Early efforts to teach efficient test use that appeared promising (Griner 1979) were generally more intent on pressuring doctors to reduce costs than on helping them determine when costs were justified, and attempts to teach them how to use information more accurately and efficiently had little impact. Knowledge of the statistical characteristics of tests was not associated with improved test selection (Greenland et al 1979), and students did not perform more efficiently on patient management problems after receiving statistical and cost‐awareness training (Williams et al 1984). Students often do not see decision‐making instruction as relevant, and they do not appear to incorporate decision‐making concepts into practice (Cebul et al 1984).…”

Section: Coping With New Cost Constraints: Can We Teach Doctors How Tmentioning

confidence: 99%

“…There are many explanations for the difficulty of teaching probabilistic concepts and related decision‐making skills. In the USA, doctors have had financial incentives to overutilize tests, lacked adequate role models and administrative support, relied on test routines, reassured patients by ordering more tests and feared legal problems if they did not (Williams et al 1984). Now that cost constraints in the USA have eliminated some of the motivation to overutilize tests, some researchers suggest that teaching decision‐making concepts there will be more effective.…”

Section: Coping With New Cost Constraints: Can We Teach Doctors How Tmentioning

confidence: 99%

Medical education for a changing future: new concepts for revising texts

Politser¹

1987

Medical Education

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“…These geographic locations have been variously identified as hospital areas (Wennberg & Gittlesohn 1982), medical market areas ((Roos 1983), hospital service areas (Brewer & Freedman 1982) or county of residence (Pasley et al 1987) and are identified using patient origin data. Other investigators have focused on the difference in physicians’ use of specific resources, particularly diagnostic and laboratory (Cummings et al 1982; Long et al 1983; Williams et al 1984; Marton et al 1985; Williams & Eisenberg 1986; Dowling et al 1987; Gortmaker et al 1988; Spiegel et al 1989; Weiner et al 1996).…”

Section: Introductionmentioning

confidence: 99%

Clinical practice guidelines: when the tool becomes the rule

Long

2001

Evaluation Clinical Practice

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This work provides a critical examination of the use of clinical practice guidelines to measure individual performance. The problems inherent in using a measure of central tendency derived from a distribution of individual performances are addressed, as is the translation of the collectively determined guidelines into a measurement instrument. It is suggested that every process on the distribution of processes used to determine the guideline must be considered equally legitimate representations of the process in question. It is further suggested that to accept as a standard of quality, a particular process simply because there is a minimum of variation between providers, is to ignore the importance of the linkage between process and outcome. The importance of an independent measure of quality based on outcomes is further emphasized by highlighting the tautological nature of analyses that include an input measure, such as nursing hours, in both the dependent variable and the list of independent variables. It is recommended that individual performance be evaluated within the tolerances of the distribution from which they were derived and not be held to some measure of central tendency of that distribution. The alternative is to use the measure of central tendency with plus or minus limits such as one, or more, standard deviations.

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Teaching Cost-Effective Diagnostic Test Use to Medical Students

Cited by 14 publications

References 12 publications

Attitudes of medical students to medical leadership and management: a systematic review to inform curriculum development

Attitudes of medical students to medical leadership and management: a systematic review to inform curriculum development

Medical education for a changing future: new concepts for revising texts

Clinical practice guidelines: when the tool becomes the rule

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