From the 2021 HVPAA National Conference
Glen Moulder (University of Virginia School of Medicine), Ashwini Niranjan-Azadi (Johns Hopkins School of Medicine), Maryellen Gusic, George Hoke, Amit Pahwa, Andrew Parsons
Approximately one in three healthcare dollars are wasted, primarily in the form of clinician-ordered unnecessary tests and treatments(1). The traditional model of American medical education has likely played a central role, promoting low-value care by focusing on thoroughness instead of appropriateness. A 2014 survey of U.S. Internal Medicine clerkship directors indicated that 91.4% of medical students somewhat or strongly agreed that high-value care (HVC) education is a responsibility of the medical school(2). Nonetheless, only 32.9% of respondents had some formal education(2). Recent calls have noted the need for more consistent HVC training in medical school, including a detailed explanation of the unique benefits associated with early introduction of HVC concepts (3). When third and fourth year medical students were removed from the clinical environment due to the COVID-19 pandemic, educators at two institutions collaboratively developed a two-week online course to teach HVC and meet the educational need for over 300 students.
The two-week course introduced students to an integrated, comprehensive model of HVC spanning value-based healthcare policy, the role of health systems science, and the use of high-value decision-making at the bedside. Through web-based instruction, readings, and collaborative discussions, the course was organized into daily themes: health systems science, value-based healthcare, quality and safety, cost, waste, diagnostic and management reasoning, prevention, high-value reproductive health, high-value prescribing, and end-of-life care. Self-directed learning was augmented by daily, virtual debriefing sessions joined by students and faculty from both institutions. As a capstone for the course, students completed an innovative exercise in pre-assigned small groups. Each group formulated a two-page proposal describing a novel method to decrease the over-utilization of a non-beneficial service in order to improve the value of healthcare in the US. The top ten proposals were selected and presented on the final day of the course to the entire cohort of students and faculty in the format of a High-Value Care Shark Tank (4). Faculty experts judged the presentations on the following criteria: inclusion of the background to the problem including references, well-delineated outcomes, creativity, feasibility, clarity of the presentation and participation of all group members.
166 students completed evaluations. Analyses of these data revealed that over two-thirds of students rated the course as “excellent” or “very good.” Most students found the online modules (153; 92.2%) and the assigned textbook reading (148; 89.2%) useful. 137 (82.5%) and 134 (80.7%) believed that creating a proposal and participating in the Shark Tank session were useful in learning the material covered in the course. In open-ended responses, students expressed that the course addressed an important and meaningful topic, helped them improve their clinical decision-making, and that the experience of working in a team was valuable.
The educational need created by the COVID-19 pandemic led to an innovative medical school HVC course. Students rated the learning experience highly and created proposals in which they applied learning with tangible suggestions to improve HVC. Next steps include development of a yearly HVC elective course and an in-depth evaluation of the Shank Tank proposals to assess the inclusion of the core principles of HVC.
Learners who train in a low-intensity care environment go on to practice high-value, cost-conscious care, while maintaining the ability to practice more aggressive care when necessary (5). This course prepares students to apply HVC principles throughout their careers.