Implementation of High-Value Care Teachings in Medical School Curriculum

From the 2023 HVPA National Conference

Eva Holland BS (Creighton University School of Medicine), Ellen Ouyang BS, Joe Largen BS, Sadie Keesler BS, Venkata Andukuri MD

High-value healthcare is an overlooked area of quality improvement that targets unnecessary medical tests and procedures to reduce harm and cost for patients. This focus often begins in residency, however implementation of high-value care teachings can help students from their first year. The Choosing Wisely campaign improves provider knowledge on high-value healthcare. Their STARS division empowers medical students to lead education initiatives, which promotes understanding from the foundations of healthcare training.

The aim of this project is to incorporate Choosing Wisely healthcare guidelines into medical student curriculum and evaluate the efficacy of this training in preparing students to provide high-value care.

To teach concepts of high-value healthcare, STARS students and faculty incorporated relevant Choosing Wisely guidelines into case-based learning sessions. This project is ongoing and will collect cumulative data across preclinical curricula. In this abstract, we present results from three system blocks from 2022: respiratory, gastrointestinal, and renal. Participants were recruited across two campuses in Nebraska and Arizona. Students’ knowledge and confidence in providing high quality care was assessed before and after case sessions by surveys using the Likert scale. Statistical analysis was performed by Student’s T test. The responses for the Likert-type questions were grouped into agree/strongly agree and disagree/strongly disagree. The proportion of responses for each category pre and post survey were compared using the Student’s T test with an alpha of 0.05.

For each organ block specific survey question, the proportion of students who self-selected into the strongly agree/agree category increased. Likewise, the proportion of students who self-selected into the strongly disagree/disagree category decreased. P-values for organ system specific questions ranged from 0.04 to 2 x 10-8. Pre and post case study survey response rates for the respiratory unit were 34.7% and 22.7% (n= 78, 51) respectively. Pre and post case study survey response rates for the renal unit were 15.1% and 11.6% (n = 34, 26). Pre And post case study survey response rates for the gastrointestinal unit were 6.2% and 6.7% (n = 14, 15).

Incorporation of these concepts into curriculum via discussion-based case-study learning increased students’ reports of confidence in utilizing high-value resources. Continued implementation of high-value care concepts into medical curriculum may lead to reduced healthcare spending.

Clinical Implications:
One of the biggest challenges to providing high-value care is changing the culture of medicine, which begins in the training stages. The training environment of healthcare practitioners greatly influences their approach to high-value care throughout their careers. Incorporating high-value care concepts into the preclinical curriculum is a widely applicable way to increase early exposure to high-value care practices.

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