From the 2022 HVPA National Conference
Lisa Yoder BS (Penn State College of Medicine), Lauren Pomerantz BS, Zach Corey BS, Kira Garry BA, MPH, Garrett Thompson BS, MPH
Over the past few decades, there has been a push to redesign the system of medical training to focus on more than just basic sciences and clinical skills to address low-quality care provided in a fragmented American health care system.1-3 This reform focuses on including a third pillar of medical education, Health Systems Sciences (HSS).4-9 HSS integrates domains of social determinants of health, population health, technology and health informatics, financing and insurance, evidence-based medicine, high-value care (HVC), and quality improvement. Despite a call to reform medical school curricula to include HSS, the significant time and institutional investment needed inhibits rapid and uniform change across institutions.10-12 While all domains of HSS are important, in order to address low-value care in America, focusing on the domains of value and quality are particularly important. Presently, extra-institutional resources are utilized to supplement undergraduate medical education (UME) and highlight specific domains of HSS. Choosing Wisely STARS (Students and Trainees Advocating for Resource Stewardship) brings together students from over 50 schools to develop collaborations and discuss addressing barriers to curricular change, high-value care (HVC), leadership, and increasing HVC in UME.13 After STARS, students at Penn State College of Medicine (PSCOM) formed a High-Value Care Interest Group (HVCIG) to further the aims of STARS and spark change at their home institution.
PSCOM’s HVCIG aims to increase awareness of value-based care and encourage innovative thinking in the healthcare systems by leading grassroots change in UME, HSS curriculum, and extra-curricular experiences. The HVCIG works to increase opportunities for students at PSCOM to learn and engage in value-based care practices.
Five PSCOM medical students across multiple years and programs formed the HVCIG with support from the HSS department and a faculty advisor. The HVCIG participates in curricula development, engages students in HSS concepts, discusses interventions within the health system, and regularly seeks feedback for improvement.
HVCIG has accomplished numerous projects in a brief period of time (see table 1), including both a PSCOM-only and national case competition in which PSCOM’s HVCIG collaborated with the Medical College of Georgia.14 Students identified and addressed instances of low-value care, proposing solutions for various clinical situations. Additionally, the HVCIG developed and implemented two, two-hour HVC classes within the HSS course, comprised of a large-group lecture portion and a small group session. Topics included: healthcare spending vs. outcomes, value, quality, value-based reimbursement models, and equity/ social determinants of health related to HVC. In small groups, students used a case to explore value stakeholders, healthcare costs, and value-added roles of students.
PSCOM’s HVCIG success demonstrates that student-led initiatives are an attainable and replicable means to implement curricular and extra-curricular opportunities. Further, medical students can be agents of change with institutional support and guidance.
The opportunities the HVCIG has implemented advance medical students’ ability to define and address instances of low-value care, improve care plans, and integrate HVC during clinical experiences, impacting the future practice and leadership of trainees.