Following the Impact of Pre-Clinical High Value Care Education

From the 2023 HVPA National Conference

Emily Turner Mallory, Bachelor’s Degree, Doctoral Candidate (University of Mississippi Medical Center), Anna Dickson, Bachelor’s Degree, Doctoral Candidate, Avery Villeret, Bachelor’s Degree, Doctor of Medicine, Caroline Doherty, Bachelor’s Degree, Doctoral Candidate, Johnny Yang, Bachelor’s Degree, Doctoral Candidate, Jayla Mondy, Bachelor’s Degree, Doctoral Candidate, Joshua Jeter, Bachelor’s Degree, Doctor of Medicine

Traditional medical education begins with two “pre-clinical” years focused mostly on basic medical concepts: the structure and functions of the body, diseases, diagnoses, and treatment concepts. While students are exposed to these topics, little emphasis on high value care (HVC) is integrated into the pre-clinical curriculum. High-value medical care is a concept that has gained significant attention in recent years. The aim is to provide safe, effective, and efficient care to patients while minimizing costs. Although medical schools have traditionally focused on teaching clinical skills, there is a growing recognition of the importance of educating students on HVC principles. Our aim was to create a course, exposing students to concepts of HVC in these pre-clinical years. Our hope was through early exposure, continued research and integration into their own studies and clinical rotations would be encouraged. Upon joining the Choosing Wisely initiative, our home institution created an elective course for first year medical students entitled “High Value Care- A Choosing Wisely Course”. Through this, students learned the pillar concepts of HVC as well as explored how to implement these concepts in their clinical years and future practices.

To evaluate the effectiveness of a program designed to teach high-value medical care principles in a medical school classroom setting to pre-clinical students.

After three consecutive years of offering the “Choosing Wisely” course at our home institution, we collected surveys from 30 participating first, second, and third year medical students to gather quantitative and qualitative information on the continuation of these principles through post-course surveys. The surveys assessed the students’ understanding of HVC concepts, attitudes towards HVC, experiences with the program, and their intention to incorporate these principles into clinical practice. 

There was a significant improvement in students’ understanding of HVC concepts, attitudes towards HVC, and intention to incorporate these principles into clinical practice. 63.3% of students surveyed strongly agreed and 36.7% agreed that they would incorporate HVC into their future medical practice. 70% strongly agreed that they feel as if they could educate peers on HVC because of the base knowledge learned through the course. The qualitative part of the survey revealed that the program was highly relevant to the students’ clinical practice and engaged learning.

This study demonstrates the effectiveness of a pre-clinical course designed to teach HVC principles in a classroom setting. The program was found to be highly relevant to medical education along with significant improvement in students’ understanding. Based on the success of the program with a small cohort, we implemented a lecture for all first-year medical students to educate and expose them to HVC. While exposing pre-clinical students to high-value care early is important, further implementation of these principles into clinical years will also be beneficial. 

Clinical Implications:
The incorporation of HVC principles in medical education has the potential to improve patient outcomes while reducing healthcare costs. Medical schools should consider implementing similar programs early on in medical education to emphasize the importance of high-value care in medical practice, no matter the clinical base knowledge of students. Future investigations may also include a comparative and statistical analysis which includes an assessment of student knowledge of HVC principles before and after HVC exposure as well as incorporations into the clinical years to further understand the role of introducing HVC in medical education.

What are academic medical centers across the country doing to improve healthcare value?

Value improvement guides: Published reviews in JAMA Internal Medicine coauthored by experienced faculty from multiple leading medical centers, with safety outcomes data and an implementation blue print.

Review article detailing 25 labs to refine for high value quality improvement | July 2020

MAVEN campaign: Free 4 year high value care curriculum online.

Join the Alliance! Membership is free with institutional approval and commitment to improving value in your medical center.

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