First-Year Medical Student Experiences with High-Value Care in Ambulatory Care

From the 2022 HVPA National Conference

Christian Hopkins BA (Johns Hopkins School of Medicine), Lynn Kao BA, Qicong Sheng BA, Meher Kalkat BS, Jacob Murphy BS, Tina Kumra MD, Amit Pahwa MD, SFHM, Ashwini Niranjan-Azadi MD


High-value care (HVC) is an essential component of medical school curricula, but students’ exposures vary by school.1,21First-year medical students’ attitudes and perceptions of HVC before taking HVC-related courses are not understood at Johns Hopkins University School of Medicine (JHUSOM).


To understand first-year medical students’ experience, comfort, and attitudes with HVC during their Longitudinal Ambulatory Clerkship (LAC), a weekly half-day ambulatory clinical rotation in outpatient family medicine, internal medicine, or pediatric clinics.


A voluntary survey relating to HVC during LAC, approved by Hopkins IRB, was distributed in February 2021 to 121 first-year medical students at JHUSOM. Descriptive and chi-square analyses were conducted in Microsoft Excel, and a Spearman’s Rank Correlation analysis was conducted in R.


There were 64 respondents (52.9%). Fifteen respondents (23.4%) reported witnessing unnecessary testing/treatment during LAC (witnessed group). Compared to those who did not (unwitnessed group), the witnessed group was not more likely to feel comfortable bringing up HVC practices to their preceptors (X2 = 0.26, p = 0.61), or to be praised by preceptors for practicing HVC (X2= 0.11, p = 0.74). Most (60% of the witnessed group and 55.1% of the unwitnessed group) felt “uncomfortable/completely uncomfortable” bringing to the attention of their preceptors about unnecessary labs/treatment, mostly (80% of the witnessed group and 83.7% of the unwitnessed group) because they reported not having enough knowledge to discuss HVC. Most respondents (73.3% of the witnessed group and 79.6% of the unwitnessed group) reported that their preceptors had never praised them when practicing HVC. The frequency that students would bring up HVC concerns was positively correlated with preceptors’ receptiveness to discussions (⍴ = 0.716, p < 0.001) and frequency of praise (⍴ = 0.645, p <0.001).


Even those first-year students who identify low value care lack knowledge to address it. Our sample size may be too small to perceive differences in experiences between those who identified low value care and those who did not. Early education can help students identify and initiate conversations about HVC with their preceptors. Preceptors’ receptiveness to discussions
and praise may encourage students to bring up HVC concerns. Analysis of year two data is currently under way.


1. Erath A, Mitchell M, Salwi S, Liu Y, Sherry A. The Sooner the Better: High-Value Care Education in Medical School. Acad Med. 11 2019;94(11):1643-1645. doi:10.1097/ACM.0000000000002881
2. Steele C, Berk J, Ashar B, Pahwa A, Cayea D. Medical students’ perceptions of low-value care. Clin Teach. 10 2018;15(5):408-412. doi:10.1111/tct.12705

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