A near-peer, online curriculum to create an national culture of high-value care

From the 2021 HVPAA National Conference

Varun Jain (University of Virginia School of Medicine), Clarissa Ren (Johns Hopkins University School of Medicine), Emily Fink, Kevin Biju, Andrew Parsons, Amit Pahwa

Background

Medical students understand that their future patient care decisions can have negative financial consequences; however, many do not know how to combat this problem. High-value care (HVC) provides a framework for understanding the impact of these care decisions; unfortunately, many medical schools do not have the curricular time to explore this topic thoroughly. As such, opportunities for self-directed learning about HVC remain the sole option for many medical students, with most offerings being asynchronous lectures and podcasts which lack opportunity for community-building and social learning. The COVID-19 pandemic provided an opportunity to utilize virtual platforms to more easily host inter-institutional didactic and discussion sessions, potentially supporting the development of a national grassroots culture of HVC.

Objective

Create and assess a near-peer, HVC curriculum to encourage the development of a national culture of HVC through cross-institutional discussion, collaboration, and social learning.

Methods

We designed and implemented a series of HVC discussions in the form of a) five traditional didactics with HVC leaders, b) three journal club discussions with authors of HVC research, and c) two “fireside chats” with healthcare industry executives. The first three sessions were didactics that provided the foundation for future discussions on HVC by defining the core problems and their drivers, as well as the solutions that HVC provides. Subsequent sessions explored a variety of topics related to the implementation of HVC. We provided optional pre- and post-surveys consisting of Likert scale, multiple-choice, and free-response questions to participating students. We performed Wilcoxon matched-pairs signed-rank test to identify changes in attitudes towards HVC for students who filled out both pre- and post-surveys.

Results

297 students from 37 medical schools and 4 countries attended at least one of the curricular sessions, and 77 students attended at least three or more sessions. 142 medical students (81% preclinical students; 19% clinical students) from 19 different schools across the United States completed the initial survey. Among the medical students who completed the initial survey, 37 medical students filled out post-surveys.

Factors that increased significantly between pre- and post-survey were familiarity of HVC, belief in physician responsibility in reducing healthcare costs, and, importantly, student comfort in initiating conversations with the team about unnecessary tests or treatments.

Conclusions

  • Medical students are willing to learn how best to provide cost-conscious care and limit the financial toxicity that the American healthcare system perpetuates.
  • Widespread implementation of HVC requires developing a culture of future physicians committed to the ideals and practices of HVC.
  • Interactive didactic sessions provide the forum for generating and sustaining interest at a period when medical schools may be unable to include these critical topics in their own curricula.
  • This virtual curriculum was successful in promoting medical students’ understanding of HVC principles and provided them with the needed vocabulary to engage in HVC discussions with their care teams, potentially causing a cultural shift towards high-value patient care.

Clinical Implications

Developing an HVC culture in the next generation of physicians may lead to improved clinical outcomes and reduced financial toxicity for patients by encouraging students to seek out and implement evidence-based, patient-centered medicine in their future practice.

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