Combining a preclinical elective course with a letter of distinction opportunity to engage medical students on high-value care

From the 2023 HVPA National Conference

Michelle Chen MPH (UC San Diego School of Medicine), Emma Williams BS, Karthik Ramesh BS, Greg Seymann MD

While a number of U.S. medical schools have begun integrating the topic of value-based medicine into medical student training, the UC San Diego School of Medicine (UCSD) core curriculum has little formal instruction in high-value care (HVC) principles. Low student engagement in extracurricular HVC-related programming was hypothesized to be the result of unfamiliarity with HVC concepts and their relevance. Elective courses, which can be developed by UCSD students and faculty, allow for opt-in instruction on topics not covered by the core curriculum.

Our goal was to create an elective course for UCSD students focused on HVC topics that would serve as a gateway to involvement in other HVC-related extracurricular opportunities.

We developed an elective course to introduce preclinical students to HVC principles, framed around Dell Medical School’s “Discovering Value-Based Health Care” online modules. To increase interest, we established a Letter of Distinction in Value-Based Medicine (VBM) that required participation in the elective course. The course was designed in a “flipped classroom” format, in which students were given protected time to complete the modules and selected readings before attending a weekly discussion group led by a faculty facilitator and centered around the week’s assigned materials. The course was administered in a virtual format in its first two years during the COVID-19 pandemic; it was subsequently held in-person during the 2022-23 academic year. Leaders of the VBM Student Interest Group at UCSD advertised the course and Letter of Distinction to first-year students during the fall interest group fair and in meetings. We collected enrollment numbers, course rating, and qualitative feedback from students.

We observed a dramatic increase in the number of enrolled students over the three-year course history, from 10 and 7 students in the first two years, respectively, to 31 students in the elective’s third year. There are multiple factors that may have contributed to this increase in enrollment, including a return to in-person learning, more effective messaging that focused on the opportunity to earn a Letter of Distinction, and attitude shifts among students as a result of the Choosing Wisely Students and Trainees Advocating for Resource Stewardship (STARS) program and VBM student interest group. The course has been consistently highly rated, averaging 9.3/10 across its three years. Students found the flipped classroom format engaging and effective, and many expressed an interest in learning more about real-world clinical examples or actionable means of applying HVC principles in clinical practice.

An HVC elective course at UCSD was an effective mechanism for growing student interest and engagement in HVC principles. In addition, adopting a flipped classroom format and using publicly available modules markedly simplified development of the course. The opportunity to earn a Letter of Distinction may have contributed to increased enrollment in the elective’s third year. Creating an HVC elective course and incentivizing participation through a Letter of Distinction may be similarly effective at other medical schools.

Clinical Implications:
An elective course may be an effective and sustainable approach for engaging medical students on HVC topics. Providing pre-clinical students with an understanding of HVC will allow them to engage more deeply with these concepts and serve as effective stewards of HVC in their clinical years.

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Review article detailing 25 labs to refine for high value quality improvement | July 2020

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