From the 2024 HVPA National Conference
Michelle Chen MPH (UCSD School of Medicine), Allison Heacock MD (The Ohio State University College of Medicine, Columbus, OH), Shivani Jain MPhil, MSc, Anitra Karthic BA, Chris Moriates MD, Karthik Ramesh BS, Hannah Shenton BS, September Wallingford RN, MSN, Nathan Yee BA, Hannah Bassett MD
Background:
The national STARS (Students and Trainees Advocating for Resource Stewardship) program catalyzes grassroots, student-led initiatives to advance health care value in medical education. STARS students have developed a robust compendium of initiatives to promote high-value care (HVC) education during preclinical years; however, few have been clerkship-oriented, despite this being the optimal period for medical students to apply HVC principles to clinical practice. Additionally, there is limited literature describing how HVC is taught within the clinical years of undergraduate medical education. To better understand the current state of and explore opportunities for integrating HVC into clerkship curricula, the STARS program created the STARS Clerkship Task Force, which is composed of program leads, STARS faculty, and six third- and fourth-year medical students who have participated in the STARS program.
Objective:
Our goal was to characterize the current landscape of HVC education during core clerkships at medical schools participating in the STARS program and to identify facilitators and barriers to implementation of HVC education in the clinical learning environment.
Methods:
The task force conceptualized, developed, and revised a survey adapted from the “Clerkship Directors in Internal Medicine” annual survey. The revised survey was designed to assess the frequency and characteristics of formal and informal HVC education in clerkship curricula, student satisfaction with these activities, how HVC competency was evaluated, and perceived barriers to HVC education. Cognitive interviewing was performed with six STARS students (not part of the task force) to assess the validity, clarity, and relevance of the revised survey. The final 20-item survey was disseminated anonymously via Qualtrics to 229 medical students in their third or fourth year of medical school and who participated in the STARS program.
Results:
We received responses from 119 students (52%), representing 40 medical schools across the U.S. Of these, 47% (n = 56) and 89% (n = 106) answered that their core clerkships contained a formal and informal HVC curriculum, respectively. Structured didactic sessions were the most common formal curricular format (71%, n = 40), but only 45% of these students (n = 18) rated didactics as “extremely effective” or “very effective.” Of all respondents, only 30% (n = 36) reported that their HVC competency was assessed during core clerkships, most often via a knowledge test. Respondents cited clinical and didactic clerkship demands and lack of faculty bandwidth as the main barriers to HVC education. Overall, satisfaction with HVC education was low, with only 20% of respondents (n = 24) stating they were “extremely satisfied” or “somewhat satisfied” with the curriculum and 63% (n = 75) stating they were “somewhat dissatisfied” or “extremely dissatisfied.”
Conclusions:
Our findings suggest significant variability in the presence and delivery of HVC education during clerkships at many U.S. medical schools. There remains a widespread lack of effective formal HVC medical education. Competing educational priorities and lack of faculty bandwidth were cited as the greatest barriers to effective HVC curricular integration, suggesting a need for creative approaches or top-down methods to encourage effective implementation of HVC education during clerkships.
Clinical Implications:
Since medical training experiences have long-lasting effects on attitudes and medical practices, HVC education during clerkships may lead to increased HVC practices. Yet significant gaps in formal education during clerkships remain. Undergraduate medical education leaders can prioritize the development, implementation, and assessment of comprehensive, standardized HVC education across core clerkships.