Integration of High Value Healthcare Principles in Preclinical Undergraduate Medical Education

From the 2023 HVPA National Conference

Shriya Das BS (University of Texas Health Science Center San Antonio Long School of Medicine), Fred Campbell MD, Raj Sehgal MD

Value-based health care (VBHC) enables physicians to provide patient-centered, evidence-based care, assessing and targeting outcomes that are most important to the patient. The VBHC framework minimizes healthcare inefficiencies that negatively impact patients, while maximizing patient outcomes.

Despite increasing adoption of VBHC frameworks in medical organizations, VBHC curriculum in undergraduate medical education is variable across schools, and data regarding student knowledge, attitude, and skills is minimal.

We sought to expose students with less prior knowledge of VBHC to foundational VBHC concepts through an introductory lecture within the preclinical curriculum. The objective of this project is to analyze the results of the student feedback and its implications on VBHC education in preclinical curriculum.

We developed a lecture given to second year medical students as part of the Medicine, Behavior, and Society (MBS) course, a longitudinal preclinical course. Leadership for the lecture came from the leaders of the VBHC student organization, faculty mentors for the organization, and course directors for the MBS course. We developed a 30-minute lecture providing students with basic knowledge and utilized a case-based interactive session.

Lecture objectives included:
– Reflecting on the current landscape of healthcare costs and outcomes in the United States
– Defining value, waste, inefficiency, outcomes of care, and costs of care
– Describing how VBHC differs from current healthcare systems
– Reflecting on financial toxicity and medical debt
– Defining costs of specific tests and procedures
– Applying VBHC frameworks to an example case

Students were asked to voluntarily complete a post-lecture survey using an anonymous Google Form. Responses were on a 5-point Likert scale.

August 2022 was the first iteration of the lecture. Approximately 60 students attended the lecture and 27 completed the survey.

Of students surveyed, 44% stated they were moderately familiar to very familiar with VBHC prior to the lecture. 30% stated they were neither familiar nor unfamiliar, 22% were moderately unfamiliar, while 4% felt very unfamiliar.

Of students surveyed, 96% stated they were very likely (74%) or moderately likely (22%) to integrate VBHC concepts into their future clinical decision-making after the lecture.
14 students left text feedback regarding the presentation. Students found the case-based learning and inclusion of real-world costs of common tests to be helpful. Students stated they would like to see additional clinical scenarios, comparisons with alternate healthcare models, and the logistics and potential pitfalls of implementation of VBHC frameworks. Additionally, students stated they would like to see further integration of VBHC concepts in their preclinical curriculum.

Our findings indicate that VBHC curriculum in undergraduate medical education is an effective method to expose students to VBHC concepts. Students demonstrated an interest in integrating VBHC into their future clinical decision-making. In feedback, they expressed a greater understanding of VBHC concepts, as well as interest in more VBHC curriculum throughout their undergraduate medical education.

Clinical Implications:
VBHC aims to maximize patient outcomes while minimizing costs through patient-centered, evidence-based care. Introducing VBHC concepts at the undergraduate medical education level enables students to develop the necessary skills and problem-solving frameworks more fully. By considering clinical problems within a VBHC model during undergraduate training, students are better equipped to provide VBHC when they enter the physician workforce.

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