Background:
An estimated one-third of national healthcare spending is waste, with the largest contribution stemming from unnecessary use of services. Published efforts to enhance cost consciousness have largely focused on residents and practicing physicians. Few curricula have been designed to educate and engage medical students in the delivery of high value care (HVC) in the clinical setting.
Purpose:
The goals of this initiative were to adapt and implement a HVC curriculum for third-year medical students on an inpatient medicine teaching service in order to drive culture change in HVC.
Description:
We created a HVC curriculum using concepts from ABIM’s Choosing Wisely Campaign, the HVC officer curriculum developed by Martin Muntz at the Medical College of Wisconsin, and situated learning theory.
The components of the HVC curriculum were as follows: 1) A 90-minute workshop on HVC for all students completing their third-year Internal Medicine clerkship at a tertiary care hospital exploring the concept of value, listing barriers to HVC, brainstorming techniques for improving value as a medical student, and learning about the American Board of Internal Medicine’s Choosing Wisely campaign through a case-based discussion. 2) Thereafter, students could volunteer to become a HVC Advocate (HVCA) for their clinical team. This optional curriculum included daily HVC rounds and HVC-themed presentations to their teams. HVCAs were provided with frequent mentorship, shared cloud-based resources on Choosing Wisely topics, local cost and charge data, presentation templates, and weekly hot topics in both the scientific and lay press.
We used the design-based research model to implement and improve this curriculum iteratively over several medical student inpatient medicine rotations (8-week blocks, July 2015-present), and to refine our theoretical framework. A total of 24 students have taken part in the workshop and 5 students have volunteered to be HVCAs. We conducted pre and post surveys to evaluate the workshop, with preliminary data showing an increase in the perceived importance of providing HVC. Self-stated barriers to providing HVC as a medical student included lack of knowledge about costs and indications, ward culture, healthcare system challenges, and lack of time. In addition, HVCAs underwent exit interviews, which showed increased confidence in discussing HVC through structured participation.
Conclusions:
We implemented a HVC curriculum for medical students on their inpatient medical rotation consisting of a mandatory workshop and additional volunteer activities. Preliminary data suggests that this curriculum improves medical student self-perceived importance in providing HVC and decreases perceived barriers in knowledge and communication. Time, culture, and systems challenges remain. HVC curricula like this may be useful to improve HVC in Hospital Medicine through the participation of undergraduate medical education learners.