From the 2022 HVPA National Conference
Hannah Shenton (Bachelor of Science in Biochemistry, The Ohio State University College of Medicine), Anitra Karthic (Bachelor of Arts), Janine Bennet (Bachelor of Science), Allison Heacock MD
Background
Rising healthcare costs in the United States are causing financial strain on patients and reducing health outcomes. One solution is integrating high-value care (HVC) into clinicians’ practices to optimize healthcare decisions while protecting patients’ financial wellbeing.
Objective
Despite the push toward HVC, there remains a paucity of training amongst pre-clinical students. We designed and integrated a pilot HVC lesson into the longitudinal “doctoring” course taken by all first-year medical students to address the lack of HVC content in the existing pre-clinical curriculum.
Methods
This lesson was a one-day, two-hour in-person experience delivered to first-year medical students. Students were assigned pre-work consisting of peer-reviewed articles and a video on the impact of financial harm on patients. Classes of twelve students each received a physician-led introductory lecture on the value shortfall, health care overtreatment, and basic principles of HVC, including the value equation. This was followed by a discussion on incorporating HVC into their clinical experiences. Next, students determined the course of treatment for a clinical scenario using “Choosing Wisely” tools. The lesson concluded with students screening standardized patients for financial harm using the GOTMeDS framework.
Students were surveyed before and after the lesson to assess their knowledge of health care overtreatment, exposure to “Choosing Wisely”, attitudes toward HVC, and HVC-related self-efficacy. Pre- and post-survey results for these four components were analyzed using paired t-tests. All components of the anonymous pre- and post-surveys were created using the 2015 medical student survey items published by Hunderfund et al. in Academic Medicine.
Results
208 first-year medical students at The Ohio State University College of Medicine participated in the Introduction to High-Value Care Lesson during their longitudinal “doctoring” class. 68 students (33%) completed both pre- and post-class surveys. Health care overtreatment knowledge improved from 71% pre-lesson to 82% post-lesson (p < 0.05). The number of students who had been exposed to “Choosing Wisely” materials improved from 12 (18%) to 59 (87%) (p < 0.001). Prior to the lesson, students were in agreement with most value- and cost-conscious attitudes according to the Likert-scale-based HVC attitude questions. After the lesson, there was a significant positive shift in two specific attitudes related to physicians’ role in preventing financial harm (p < 0.05 for both). Students reported self-efficacy scores regarding their ability to find information on HVC to inform clinical decision-making and integrate information about HVC into clinical decision-making on a scale of 0-10 (0 = no confidence, 10 = complete confidence). The averages improved from 5.07 and 5.19 to 6.71 and 6.56, respectively (p < 0.001 for all values).
Conclusions
This pilot lesson was developed in response to gaps in the pre-clinical curriculum surrounding HVC and cost-conscious practices. Overall, students’ exposure and knowledge of “Choosing Wisely” and HVC improved after this introductory lesson. By the end of the lesson, all students were in agreement with the value-based care beliefs assessed. Finally, students’ self-efficacy associated with finding HVC information and integrating it into their clinical practices significantly improved. Limitations of this evaluation include a low post-class survey response rate and variability of teaching styles among the class instructors.
Clinical Implications
This pilot lesson displays the potential that adding HVC-focused material into longitudinal small group sessions can have in strengthening first-year medical students’ HVC knowledge and skills that can be applied in their clinical careers.
