From the 2021 HVPAA National Conference
Benjamin Dralle (The Ohio State University College of Medicine), Michael Ioerger, Allison Heacock
Background
Across the United States, rising health care costs have become a significant concern for patients, physicians, and other health care stakeholders. Medical education communities have responded to this concern in several ways, including the promotion of high-value care (HVC) as a solution to the affordability crisis.
Objective
Despite the growing popularity of HVC, few opportunities exist for pre-clinical medical students to learn about HVC. We designed an elective course to fit into students’ pre-existing elective time to address this educational gap.
Methods
This course was a two-day, eight-hour online experience delivered to first- and second-year medical students. Day One began with an introductory lecture covering the value shortfall, financial harms, and health care overuse. It then progressed to a second lecture discussing basic HVC principles, including the value equation and health care financing. This day concluded with a case-based review of the “Choosing Wisely” campaign.
Day Two started with an interactive session focused on assessing value in the medical literature and proceeded to a second session examining strategies for discussing health care value with supervisors and interprofessional colleagues. Students then received a lecture on HVC advocacy, and the course culminated with a physician panel featuring value leaders from across our health care system.
Students were surveyed prior to and following the course to assess their exposure to “Choosing Wisely”, HVC knowledge, and HVC-related self-efficacy. Attitudes toward cost-conscious care were evaluated using the 2015 medical student survey items published by Hunderfund et al. in Academic Medicine. Pre- and post-survey results were analyzed using odds ratios for “Choosing Wisely” exposure and HVC knowledge, Chi-squared tests for attitude measures, and paired t-tests for self-efficacy.
Results
57 students enrolled in the course, and 53 (93%) completed both pre- and post-course surveys. The number of students who had seen “Choosing Wisely” materials improved from 1 (2%) to 48 (91%) (OR 499.20, 95% CI: 56.28-4427.66), and the percentage of students who correctly answered three questions about health care overuse 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). When asked to rate their self-efficacy on a 0-10 scale, the average rating improved from 4.36, 4.66, and 4.87 to 8.66, 8.25, and 8.23, respectively, for students’ ability to find HVC information to inform clinical decision-making, integrate HVC information into clinical decision-making, and integrate HVC practices into their clinical practice (p < 0.001 for all values).
Conclusions
In summary, this course was designed as a response to educational needs, and students’ “Choosing Wisely” and HVC knowledge improved after taking the course. Furthermore, their attitudes moved toward value- and cost-conscious beliefs for all items assessed. Finally, their self-efficacy related to finding HVC information and integrating it into their clinical practice increased significantly.
Clinical Implications
This elective course has demonstrated that it can provide students with a foundation of HVC knowledge and skills, as well as improved HVC-related self-efficacy, that can be applied throughout their clinical careers.
