Comparing the Outcomes of a Two-Day High-Value Care Elective Course for Pre-Clinical Medical Students through Online and In-Person Formats

From the 2022 HVPA National Conference

Alexia Markowski, Bachelors of Science (The Ohio State University College of Medicine), Avani Kabra Undergraduate, B.S., Tiffany Guan Undergraduate, B.S., Janine Bennet Undergraduate, B.S., Benjamin Dralle Undergraduate, B.S., Michael Ioerger MD, PhD, Allison Heacock MD

As increasing healthcare costs continue to pose challenges to patients and providers, medical schools have worked to emphasize high-value care (HVC) principles. During the pandemic, schools faced a new challenge of delivering their curriculum in hybrid or online formats. A HVC course for pre-clinical medical students was developed and taught virtually in 2020 and in-person in 2021. The objectives of this study were to assess the impact of the in-person course on students’ HVC knowledge, attitudes, and self-efficacy and compare the outcomes to those demonstrated by the virtual course.

The HVC course took place over two, four-hour days both virtually and in-person. The first day included introductory lectures about HVC, healthcare financing and delivery, and a case-based activity using the “Choosing Wisely” app. The second day focused on assessing HVC in the literature, practical tips for having value conversations, a physician panel, and an overview of HVC resources. For the in-person course, all 32 students completed a pre-survey to determine any previous knowledge of HVC and the “Choosing Wisely” program. Their attitudes towards cost-conscious care were evaluated using previously published survey items (Hunderfund et al. 2015). 24 students (75%) completed the post-course survey. Odds ratios, Fisher’s exact tests, and paired t-tests analyzed HVC knowledge and exposure, cost-conscious attitudes, and HVC self-efficacy, respectively.

After the in-person course, the percentage of students who had seen the “Choosing Wisely” campaign and associated materials increased significantly from 4% to 100% (p < 0.001). For two questions about HVC-specific knowledge, students were significantly more likely to answer correctly after the course (OR: 5.91, 95% CI: 1.55-22.58; OR: 35.48, 95% CI: 1.93-651.65). Student attitudes shifted towards more cost-conscious care for 4 out of 21 questions (p < 0.05). For the remainder, most students demonstrated attitudes supporting cost-conscious care before the course, and afterwards, the distribution of responses remained the same. When rating their self-efficacy on a 0-10 scale, students’ average ratings improved from 4.75, 4.54, and 4.83 to 8.58, 8.00, and 8.42, respectively, for the ability to find HVC information, integrate HVC information into clinical decision-making, and integrate HVC practices into clinical practice (p < 0.001 for all values). In the virtual course, the percentage of students who correctly answered questions about HVC-specific knowledge improved from 60% to 91% (OR 6.80, 95% CI: 3.61-12.81); students displayed positive shifts toward value- and cost-conscious attitudes for all survey items (p < 0.045 for all items).

The in-person HVC course led to improvements in students’ HVC knowledge, attitudes towards cost-conscious care, and HVC-related self-efficacy. Both virtual and in-person courses showed improvements, with the former yielding more significant results. Areas for further study include evaluating written feedback to qualitatively determine students’ perception of the course. This feedback will be combined with quantitative measures to help improve the course in the future. Both virtual and in-person courses helped students gain knowledge in HVC principles which can be applied throughout their medical education and training.

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