Cornelius James (University of Michigan)
It is challenging to add new material to crowded curricula. Duty hour restrictions and the large amount of information that residents must learn, make proper prioritization and efficiency important. The ACGME requires that programs ensure that residents are able to competently use the medical literature and consciously consider cost.
- Residents will learn to provide value-based, cost-conscious care. They will also develop the skills necessary to teach interns and medical students value-based medicine.
- Residents will learn to competently and confidently critically appraise the medical literature to practice evidence-based medicine. They will also develop the skills necessary to teach the principles of evidence-based medicine to interns and medical students.
Senior internal medicine residents meet for 1-2, sessions monthly to discuss topics related to evidence and value-based medicine (EVBM). Principles of EVBM are taught in a “”hybrid”” or integrated fashion. Sessions are interactive, and conducive to self-reflection and idea-sharing. The sessions focus on patient cases and related, recently published (within 3 years) articles. Older, landmark articles may be used to fulfill specific learning objectives. Learners receive relevant articles and critical appraisal worksheets prior to the learning session. They are expected to have independently appraised the article and to participate in the in-class discussion. After the literature is appraised collectively residents are encouraged to carefully consider costs, and value to the individual patient presented in the case.
Educational methods include a flipped classroom, large group discussion, small group discussion, team-based learning, reflection on experience, and role-playing.
- Incorporating Evidence and Value-Based Medicine into Teaching
- Evidence and Value-Based Diagnosis and Screening
- Evidence and Value-Based Decision Making and the Patient
- Evidence and Value-Based Therapy/Treatment
At the conclusion of each session learners complete a brief feedback survey to assess attitudes related to EVBM, and teaching methods.
Thus far, 18 post-session surveys for the Evidence and Value-Based Decision Making and the Patient session have been completed.
100% of residents either agreed or strongly agreed with the following:
- Because of this session I am more likely to consider a patient’s circumstances (goals, values, preferences, etc) when recommending interventions.
- I have a better understanding of the various decision making approaches to assist patients in making decisions regarding their health.
- I am more likely to use a shared-decision making approach when assisting patients with healthcare decisions.
Selected statements from learners (Name two things that you appreciated about this session.):
- “Actually useful information”
- “Having a clearer understanding of shared decision making.”
- “Learning more about decision making tools for patients.”
- “Practical/helpful sources”
- “That it was interactive”
- “It was well organized and thought provoking.”
- “I appreciated the role play exercise.”
- “Good summary of different styles of relationship.”
A combined EVBM curriculum is an efficient way to teach two disciplines that are integral to the effective care of the patient. With the amount of overlap between evidence and value-based medicine, teaching them in a hybrid fashion is reasonable. In the future we will assess attitudes related to the other 3 sessions. Knowledge transmission will also be assessed with pre-tests and post-tests.
Implications for the Patient
A resident’s ability to critically appraise the medical literature, and determine the costs, and value of the care that they provide is essential to effective care and will likely lead to improved patient outcomes and satisfaction.