High-Value Care in Pre-Clinical Medical Education: A Pilot Study of an Integrated Longitudinal Curriculum

From the 2022 HVPA National Conference

Hope Schwartz BA (University of California San Francisco), Elle Clelland BA, Leslie Zimmerman MD, Dana Rohde PhD, Chris Moriates MD, Ari Hoffman MD


Health care affordability is a growing area of concern in the US, with increasing emphasis on the role of physicians in practicing high value care (HVC). However, principles of HVC are not historically taught in undergraduate medical education, and there are no existing published curricula for preclinical learners.


We aimed to create, pilot, and evaluate a longitudinal, integrated HVC curriculum for pre-clinical medical students at the University of California San Francisco (UCSF) School of Medicine.


Given the time constraints of the existing pre-clinical schedule, we created a curriculum designed to maximize learning while minimizing course time. Our curriculum was included in the first-year Airways, Breathing and Circulation (ABC) course, so students were exposed to material early in their pre-clinical learning. The curriculum included three components: 1) a foundational introduction to HVC video module developed with HVC faculty experts; 2) HVC clinical learning objectives (LOs) developed in collaboration with clinical lecturers and integrated into existing clinical lectures in the form of 1-2 powerpoint slides; and 3) corresponding multiple choice quiz questions delivered in students’ weekly quizzes to reinforce the LOs. We evaluated student perspectives on the course using a post-course Qualtrics survey delivered via email.


Our curriculum was delivered to 161 students during the seven-week Airways, Breathing and Circulation course in Fall 2020 at UCSF. Sixty students completed the post-course survey for a response rate of 37.3%. The total time of our longitudinal curriculum was 40 minutes (20 minute introductory module and 20 minutes of lecture material delivered over four lectures), in addition to four multiple choice questions. In collaboration with clinical lecturers and topic experts, LOs developed included 1) outpatient management of hypertension; 2) intervention for symptomatic angina; 3) anticoagulation selection and financial history taking; and 4) workup for pulmonary embolism. Prior to the course, 26% of students felt that HVC should be incorporated into the preclinical curriculum, which increased to 76% after the course. By curricular element, students rated the clinical LOs delivered during lectures as the most impactful, with 90% of students surveyed stating that the LOs were helpful to learning principles of HVC. 76% felt the foundational module was helpful, and 76% of students felt the multiple choice quiz questions were helpful.


Our HVC pilot course demonstrated that pre-clinical students desire more HVC education and that curriculum can be delivered early and longitudinally, without impacting the pre-existing curriculum. Ongoing work at the UCSF School of Medicine is aiming to expand this longitudinal curricular model into additional pre-clinical systems-based blocks.

Clinical Implications

The results of our study suggest that teaching HVC in pre-clinical medical education may impact student knowledge, attitudes, and interest with respect to HVC. Future research will aim to examine the impact of this pre-clinical curriculum on students’ clinical decision-making during clinical rotations.

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.

Learn more about HVPA on Health Affairs Blog