Laying Quality in the Foundation: Creating a High-Value Care Unit in Undergraduate Medical Education

From the 2022 HVPA National Conference

Zach Corey (Medical Degree, Penn State College of Medicine), Kira Garry (Medical Degree), Lisa Yoder (Medical Degree), Lauren Pomerantz (Medical Degree), Garrett Thompson (Medical Degree), Brian McGillen (Medical Degree)


Despite spending more than any other developed nation on health care, the United States consistently has worse health outcomes (e.g. disease burden, life expectancy). In addition, nearly 25% of this spending is wasteful, exposing patients to unnecessary procedures and contributing to prohibitive costs of care [1,2]. To reduce this waste and improve quality of care, there has been a growing call to incorporate discussion of quality and high-value care (HVC) into medical education [3-5]. Educating health professionals on HVC reduces inappropriate interventions and costs, while increasing incorporation of shared decision making [6]. However, medical students feel underprepared with the limited HVC training during medical school. They desire more education on costs of care, quality initiatives, and the incorporation of HVC into clinical practice [7,8]


The objective of the HVC unit was to better prepare undergraduate medical students to practice HVC during clerkships and into their career. This was achieved by providing specific education on HVC within their HSS course whereby student were given a framework for HVC and provide a simulated opportunity for to implement HVC.


Medical students with guidance from Health System Science (HSS) Faculty at their home institution collaborated to develop a HVC unit within the first year medical student and physician assistant HSS curriculum. The unit consisted of two, two-hour class sessions taught by the medical student authors. Each session included a brief large-group lecture to teach foundational concepts of HVC (e.g. value equation, quality, fee for service vs value reimbursement, Choosing Wisely Guidelines) followed by a longer, interactive small-group session. Small-group sessions utilized a case vignette with activities focused on identifying low-value care and understanding quality (session 1) and proposing HVC solutions (session 2).


Upon completion of the unit, students were able to: (1) Describe the current state of waste in health care by focusing on health outcomes in the United States compared to cost; (2) Define the value equation and demonstrate how it is used in health care (3) Discuss the concept of quality in health care; (4) Compare and contrast fee-for-service and value reimbursement; (5) Discuss how HVC and value reimbursement connects to health care equity and equality; (6) Compare and contrast high-value and low-value care using clinical examples and the Choosing Wisely guidelines; and (7) Create solutions to promote HVC in the clinical setting.


From the development of this HVC unit, we were able to demonstrate that medical students are capable of developing and implementing a HVC curricular session for other students, with limited guidance from faculty. Following each session, the medical student authors received and incorporated feedback from faculty and students. The authors are incorporating this evaluation and feedback to improve sessions for future iterations of the HVC Unit.

Clinical Implications

Educational initiatives such as a HVC unit give students practice engaging in and providing HVC. Early exposure to HVC in medical school curricula allows students to integrate HVC practices as they form habits that will follow them into clerkships and their career as physicians.

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