Amit Pahwa (Johns Hopkins School of Medicine), Heather Harrell (University of Florida), Maria Minickiello (Aquifer)
The American Association of Medical Colleges (AAMC) recommends that upon completion of medical school, students are able to select and interpret diagnostic and screening tests using evidence-based and cost-effective principles. However, internal medicine clerkship directors cite lack of time in curriculum as biggest barrier to teaching high value care.
Creating and assessing the use of an online national high value care curriculum for medical students that can be incorporated easily into current curricula.
Aquifer, the American College of Physicians (ACP), and the Alliance for Academic Internal Medicine (AAIM) developed an on-line High Value Care (HVC) curriculum specifically for medical students using the objectives from the ACP HVC Curriculum. The curriculum addressed care in the inpatient and ambulatory practice settings for both pediatric and adult populations.
Each case was developed by a physician and education specialist. Once written the cases underwent further peer review by other team members in Aquifer. Six cases were released in 2014 and another six were released in 2015. An optional survey was added to all the cases in October 2015. In addition, usage statistics were obtained through the learning management system.
There were 129 schools that had at least one user with an average of 28 users per school (Range: 1-419). From the first set of cases, there was an average of 1445 finished sessions. The most popular was an introduction to high value care (1913 sessions) and the least popular was on medications and value (1151 sessions). From the second set of cases there was an average of 704 completed sessions. The most popular was on appropriate evaluation of pediatric abdominal pain (851 sessions) and the least popular was on reproductive health (623). Average time in each session was 19 minutes.
A total of 626 students from 27 medical schools completed the survey at least once with the total number of responses from each school ranging from 1 – 176. The great majority of students indicated that the HVC cases were relevant to their learning (86%) and that the information was presented at an appropriate level (89%). These findings held true for each case individually as well as collectively; no case was an outlier.
The method of delivery and the content of the cases—short, focused on a limited number of key points—are deemed by the vast majority of student respondents to be “about right” and are not considered too elementary or too advanced. Each case only took 19 minutes on average and could easily be incorporated into any medical school curriculum. Usage data did not show if these modules were completed during non-clerkship or clerkship years.
Implications for the Patient
While these have no direct implications for patient care, introducing students to high value care and incorporating into the culture may lead them ordering less unnecessary testing and treatments.