Development and Implementation of a Novel Clerkship Bundle to Promote High-Value Care Behaviors among Clerkship-level Medical Students

Background:
While significant strides have been made in advancing high-value care (HVC) awareness and engagement in preclinical undergraduate medical education, there is limited literature on efforts directed at clerkship-level students, who likely have the clinical context to more fully appreciate HVC principles. However, the challenge posed by competing learning priorities in the clerkship years can be a barrier to student involvement in HVC initiatives during this period. We decided to take a pragmatic approach toward developing an intervention in which application of HVC principles accompanies and enhances traditional clinical learning objectives.

Objective:
Our goal was to develop a clerkship-oriented HVC intervention—comprising a clerkship toolkit, distinction award in HVC, and badge cards—and to elicit student feedback on the organization, content, and usability of the HVC clerkship toolkit.

Methods:
We intentionally approached the design of the clerkship bundle to include compelling incentives for use and minimal barriers to access. The HVC clerkship bundle is comprised of the HVC Clerkship Toolkit (see attachment)—a cloud-based repository of relevant resources and HVC strategies—a newly created Clinical Distinction Award in HVC to incentivize participation and recognize exemplary engagement, and badge cards with a QR code linking to the toolkit for easy mobile access. We performed a series of semi-structured interviews with five medical students who recently completed their third year to solicit their feedback on the content, structure, and usability of the toolkit, as well as suggestions for improvements. Students interviewed included previous STARS (Students and Trainees Advocating for Resource Stewardship) program participants as well as students with no prior HVC background. Feedback from these interviews informed revisions prior to implementation.

Results:
The HVC Clerkship Toolkit is divided into subfolders, each dedicated to an HVC-related topic or resource, including an introduction to HVC, society guidelines, the SOAP-V framework, an inpatient daily progress note checklist, quick-reference pocket guides, and a primer on health care costs. There was an emphasis on providing clear, actionable strategies for applying HVC principles to clinical practice at the third-year level. Where possible, we incorporated established HVC resources. Feedback from outgoing third-year students was strongly positive regarding the format, content, and perceived clinical utility of the toolkit. Minor changes were made to the toolkit’s organization and content prior to launch. The final version of the clerkship bundle was introduced and implemented during the Medicine core clerkship orientation. We will evaluate the impact of our intervention on medical student perspectives of HVC and confidence in applying HVC principles using surveys adapted from the HVC literature.

Conclusions:
To better integrate HVC education into clinical training during the clerkship years, we created, tested, and implemented a novel HVC clerkship bundle centered around the HVC Clerkship Toolkit, with supplementary components to encourage student engagement with the toolkit.