Incorporation of High Value Care Communication Techniques Into Pre-clerkship Clinical Skills Curriculum: A Standardized Patient With Knee Pain

From the 2022 HVPA National Conference

Rayghan Larick BS, Med (Eastern Virginia Medical School), Matilda Francis BA, MPH, Riccardo De Cataldo BS, Erika Rhone MD, Amelia Wallace MMHPE, Lauren Mazzurco DO

Background

Eastern Virginia Medical School has integrated high-value care (HVC) content into undergraduate medical education curriculum. Skill set practice of HVC communication techniques however has been lacking. Prior needs assessments revealed that students were eager to practice these communication skills prior to clinical clerkships.

Objective

This initiative allowed first-year (M1) medical students to apply Choosing Wisely recommendations into their clinical reasoning and communication skills during a standardized patient (SP) encounter.

Methods

Students completed a one-hour workshop on HVC communication skills, followed by an SP encounter during the Skin, Muscle, Bone module of M1 year. The existing case encounter in the module, focused on knee pain was updated to incorporate challenge statements from the SP that would prompt a discussion about HVC principles (e.g. the SP asked about additional, but medically unnecessary, imaging tests). Students were instructed to use HVC communication techniques from the workshop to engage the patient in shared decision making and discussion of high value diagnostic testing. Afterwards, faculty facilitators led a small group discussion about specific communication skills used, individual and system-level consequences of unnecessary tests, and engaging other health care team members in HVC discussions. Faculty facilitators were provided a facilitator guide with the appropriate HVC communication skills, Choosing Wisely recommendations applicable for knee pain, and suggested responses to the discussion questions as a reference. SPs were trained to provide feedback on the application of HVC communication skills from a patient’s perspective. Students completed pre- and post-surveys to assess the effectiveness of the HVC additions to the Clinical Skills case.

Results

Pre-session surveys were completed by 119 M1 students; 78 completed the post-survey. Chi-square analysis of pre- and post- surveys revealed a statistically significant increase (difference = 25.2%, 95% CI 2.74 – 26.26%, p = 0.02) in percentage of respondents who agreed or strongly agreed with the statement, “As a student I feel comfortable in my knowledge of HVC principles.” There was also a statistically significant increase in percentage of respondents selecting confident or very confident in their skillset regarding meaningful conversations surrounding HVC with patients before and after the encounter (47.9% pre-session vs 73.1% post-session, difference = 25%, 95% CI 11.24 – 37.47%, p = 0.0005). 87.2% of students agreed or strongly agreed that practicing discussions surrounding HVC with SPs was a valuable experience.

Conclusions

HVC communication techniques integrated into an existing SP encounter in the M1 year were valuable to the student experience without significantly affecting the structure or the dedicated time for the encounter or the workshop. Incorporation of HVC communication techniques into the M1 Clinical Skills curriculum was logistically feasible and positively impacted students’ knowledge and comfort with HVC principles.

Clinical Implications

Students had an opportunity to operationalize knowledge and skills around HVC communication techniques in the M1 year; skills applicable to early clinical experiences and future clinical rotations. We anticipate future opportunities to incorporate intentional practice into pre-clerkship and clerkship phases to reinforce importance and value of these skills.

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