Teaching high-value care: a novel morning report

Abstract

A morning report incorporating cost of care can significantly increase trainees' perceived understanding of cost and affect self-reported ordering practices in an educationally valuable intervention.

Interactive value‐based curriculum: a pilot study

“…Additionally, the Choosing Wisely campaign provides educational tools for doctors and patients to challenge health care workers to eliminate costly interventions of low clinical benefit . Training programmes nationwide have begun implementing VBC curricula, with most published descriptions reporting one‐time educational interventions or limited assessments of changes in the learner's knowledge or self‐reported changes in attitudes and awareness of cost, which sit at the ‘knows’ level and base of Miller's pyramid of assessment . When ascending Miller's pyramid to ‘knows how’, ‘shows how’ and ‘does’, studies become more limited.…”

“…Previously, we found an increase in residents’ self‐reported knowledge of costs and increased likelihood to practice VBC following a single morning report (MR) incorporating cost‐of‐care information, with residents ‘paying’ for a diagnostic evaluation . Based on this initial success, we developed a more robust multi‐session VBC MR curriculum and an assessment at the higher ‘knows how’ level, with the following goals: (1) to teach residents principles of VBC using active learning strategies; and (2) to develop and pilot an assessment of residents’ ability to apply principles of VBC using simulated written clinical cases to evaluate the effectiveness of the curriculum.…”

Incorporating High Value Care into Undergraduate Medical Education

“…Because many residency programs have started to incorporate HVC into their curriculum, a partnership between UME and GME curricula could be beneficial to provide medical students with practical examples of HVC. [17] Ultimately to create a successful pilot program, the enthusiastic involvement of faculty, staff and students is crucial to make a curriculum that will meet the goals we set forward. We believe these small but significant changes to the UME curriculum will produce residents and future physicians who are increasingly savvy about diagnostic test ordering, and who see the tools available as resources whose benefit must be carefully considered prior to their use.…”

Use of the morning report to teach high-value care

“…I was interested to read the description of the high‐value care morning report by Bowman et al . Academic medical centres (AMCs) provide more expensive care than their non‐academic counterparts, in part because of factors that may be modifiable with trainee education .…”

“…Furthermore, in my experience, interprofessional pressures inherent in a hierarchical practice model push trainees to order excessive diagnostic testing in order to demonstrate their breadth of knowledge to their attending physicians. Finally, inexperienced trainees are unlikely to have an adequate knowledge of the costs of the diagnostic tests that they order …”