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Barone MA, Carraccio C, Lentz A, Englander R. Without medical education, a learning healthcare system cannot learn. BMJ LEADER 2024:leader-2023-000746. [PMID: 39025487 DOI: 10.1136/leader-2023-000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/26/2024] [Indexed: 07/20/2024]
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Niehus H, Gunesch AN, Rodriguez N, Khoury J, Ma A, Gu N, Cao T, Muller M, Moriates C, Linker AS, Prochaska M, Fish D, Moulder G, Stephens M, Carney PA, Smeraglio A. Factors Associated with Medical Students' Attitudes About Cost-Conscious Care: A Mixed-Methods Multi-school Study. J Gen Intern Med 2024:10.1007/s11606-024-08783-x. [PMID: 38710863 DOI: 10.1007/s11606-024-08783-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/22/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Because physician practices contribute to national healthcare expenditures, initiatives aimed at educating physicians about high-value cost-conscious care (HVCCC) are important. Prior studies suggest that the training environment influences physician attitudes and behaviors towards HVCCC. OBJECTIVE To explore the relationship between medical student experiences and HVCCC attitudes. DESIGN Quantitative and qualitative analysis of a multi-institutional survey. PARTICIPANTS Medical students from nine US medical schools. APPROACH A 44-item survey that included the Maastricht HVCCC Attitudes Questionnaire, a validated tool for assessing HVCCC attitudes, was administered electronically. Attitudinal domains of high-value care (HVC), cost incorporation (CI), and perceived drawbacks (PD) were compared using one-way ANOVA among students with a range of exposures. Open text responses inviting participants to reflect on their attitudes were analyzed using classical content analysis. KEY RESULTS A total of 740 students completed the survey (response rate 15%). Students pursuing a "continuity-oriented" specialty held more favorable attitudes towards HVCCC than those pursuing "technique-oriented" specialties (HVC sub-score = 3.20 vs. 3.06; p = 0.005, CI sub-score = 2.83 vs. 2.74; p < 0.001). Qualitative analyses revealed personal, educational, and professional experiences shape students' HVCCC attitudes, with similar experiences interpreted differently leading to both more and less favorable attitudes. CONCLUSION Students pursuing specialties with longitudinal patient contact may be more enthusiastic about practicing high-value care. Life experiences before and during medical school shape these attitudes, and complex interactions between these forces drive student perceptions of HVCCC.
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Affiliation(s)
- Hunter Niehus
- Department of Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA
- Portland Veterans Hospital Administration, Portland, OR, USA
| | - Ali Noel Gunesch
- Department of Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA
| | - Nina Rodriguez
- Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA
| | - Julianna Khoury
- Dell Medical School at The University of Austin, Austin, TX, USA
| | - Annie Ma
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Nina Gu
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Thy Cao
- William Carey University College of Osteopathic Medicine, Hattiesburg, MS, USA
| | - Megan Muller
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Christopher Moriates
- Costs of Care, Boston, MA, USA
- VA Greater Los Angeles Healthcare System and UCLA, Los Angeles, CA, USA
| | - Anne S Linker
- Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA
| | - Micah Prochaska
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - David Fish
- University of Massachusetts Chan Medical School Bay State, Northampton, MA, USA
| | - Glenn Moulder
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Melissa Stephens
- William Carey University College of Osteopathic Medicine, Hattiesburg, MS, USA
| | - Patricia A Carney
- Department of Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA
| | - Andrea Smeraglio
- Department of Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA.
- Portland Veterans Hospital Administration, Portland, OR, USA.
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Bronner KK, Goodman DC. End-of-life cohorts from the Dartmouth Institute: risk adjustment across health care markets, the relative efficiency of chronic illness utilization, and patient experiences near the end of life. RESEARCH IN HEALTH SERVICES & REGIONS 2024; 3:4. [PMID: 39177848 PMCID: PMC11281768 DOI: 10.1007/s43999-024-00039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/14/2024] [Indexed: 08/24/2024]
Abstract
Since their inception, small area studies intended to measure health system performance have been challenged by concerns that regional variation in health care may be primarily explained by differences in patient health risk. Controlling for regional population differences depends on appropriate risk adjustment, but the adequacy of the methods used in early analyses was contested. A novel response to these concerns was the development of end-of-life cohorts by Dartmouth Atlas investigators. These were used initially to control for differences in population health status in studies investigating relative efficiency across regions. Later, they became useful for studying hospital-level variation in chronic illness care, and for measuring utilization and patient experiences at the very end of life. Altogether, end-of-life cohorts have been invaluable for clarifying the contribution of health system and provider factors to health care variation and outcomes.
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Affiliation(s)
- Kristen K Bronner
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH, 03756, United States.
| | - David C Goodman
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH, 03756, United States
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Reilly JB, Kim JG, Cooney R, DeWaters AL, Holmboe ES, Mazotti L, Gonzalo JD. Breaking Down Silos Between Medical Education and Health Systems: Creating an Integrated Multilevel Data Model to Advance the Systems-Based Practice Competency. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:146-152. [PMID: 37289829 DOI: 10.1097/acm.0000000000005294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
ABSTRACT The complexity of improving health in the United States and the rising call for outcomes-based physician training present unique challenges and opportunities for both graduate medical education (GME) and health systems. GME programs have been particularly challenged to implement systems-based practice (SBP) as a core physician competency and educational outcome. Disparate definitions and educational approaches to SBP, as well as limited understanding of the complex interactions between GME trainees, programs, and their health system settings, contribute to current suboptimal educational outcomes elated to SBP. To advance SBP competence at individual, program, and institutional levels, the authors present the rationale for an integrated multilevel systems approach to assess and evaluate SBP, propose a conceptual multilevel data model that integrates health system and educational SBP performance, and explore the opportunities and challenges of using multilevel data to promote an empirically driven approach to residency education. The development, study, and adoption of multilevel analytic approaches to GME are imperative to the successful operationalization of SBP and thereby imperative to GME's social accountability in meeting societal needs for improved health. The authors call for the continued collaboration of national leaders toward producing integrated and multilevel datasets that link health systems and their GME-sponsoring institutions to evolve SBP.
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Wang Y, Hu S, Yao J, Pan Y, Wang J, Wang H. Clinical nursing mentors' motivation, attitude, and practice for mentoring and factors associated with them. BMC Nurs 2024; 23:76. [PMID: 38287369 PMCID: PMC10826088 DOI: 10.1186/s12912-024-01757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE To investigate the motivation, attitude, and practice toward mentoring and related factors among clinical nursing mentors. METHODS This cross-sectional study included clinical nursing mentors from 30 hospitals in Zhejiang Province between August and September 2023. Demographic information, motivation, attitude, and practice were collected through a self-administered questionnaire. RESULTS A total of 495 valid questionnaires were collected, and most of the participants were 30-39 years old (68.7%). Average motivation, attitude, and practice scores were 29 [26, 32] (possible range: 8-40), 87 (82, 94) (possible range: 22-110), and 41 (38, 45) (possible range: 11-55), respectively. Correlation analyses showed that the motivation scores were positively correlated with attitude scores (r = 0.498, P < 0.001) and practice scores (r = 0.408, P = 0.001), while attitude scores were positively correlated with practice scores (r = 0.554, P < 0.001). Multivariate logistic regression showed that intermediate and senior nursing mentors (OR = 0.638, 95% CI: [0.426-0.956], P = 0.030) and different hospitals (OR = 1.627, 95% CI: [1.054-2.511], P = 0.028) were independently associated with motivation. The hospital's frequency of psychological care was a significant factor associated with nursing mentoring motivation, attitude, and practice. Participation in training (OR = 2.908, 95% CI: [1.430, 5.913], P = 0.003) and lower frequency of job evaluation in hospital ("Often": OR = 0.416, 95% CI: [0.244-0.709], P = 0.001 and "Sometimes": OR = 0.346, 95% CI: [0.184-0.650], P = 0.001) were independently associated with practice. CONCLUSION Clinical nursing mentors had adequate motivation, positive attitude, and proactive practice towards mentoring and associated factors. Clinical nursing mentorship should be enhanced by prioritizing mentor training, fostering a supportive environment with consistent psychological care, and promoting structured mentorship activities.
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Affiliation(s)
- Yan Wang
- Nursing Institute, Ningbo College of Health Science, Ningbo, 315100, P.R. China.
| | - Suzhen Hu
- Nursing Institute, Ningbo College of Health Science, Ningbo, 315100, P.R. China
| | - Jiali Yao
- Delivery and Labor Room, Zhejiang University Mingzhou Hospital, Ningbo, 315100, P.R. China
| | - Yangmiao Pan
- Department of Infectious Diseases, Ningbo No.2 Hospital, Ningbo, 315000, P.R. China
| | - Junling Wang
- Department of Obstetrics, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, P.R. China
| | - Hua Wang
- Nursing department, Zhejiang University Mingzhou Hospital, Ningbo, 315100, P.R. China
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Bond WF, Mischler MJ, Lynch TJ, Ebert-Allen RA, Mou KM, Aiyer M, Park YS. The Use of Virtual Standardized Patients for Practice in High Value Care. Simul Healthc 2023; 18:147-154. [PMID: 35322798 DOI: 10.1097/sih.0000000000000659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study examined the influence of high value care (HVC)-focused virtual standardized patients (VSPs) on learner attitudes toward cost-conscious care (CCC), performance on subsequent standardized patient (SP) encounters, and the correlation of VSP performance with educational outcomes. METHOD After didactic sessions on HVC, third-year medical students participated in a randomized crossover design of simulation modalities consisting of 4 VSPs and 3 SPs. Surveys of attitudes toward CCC were administered before didactics and after the first simulation method. Performance markers included automated VSP grading and, for SP cases, faculty-graded observational checklists and patient notes. Performance was compared between modalities using t tests and analysis of variance and then correlated with US Medical Licensing Examination performance. RESULTS Sixty-six students participated (VSP first: n = 37; SP-first: n = 29). Attitudes toward CCC significantly improved after training (Cohen d = 0.35, P = 0.043), regardless of modality. Simulation order did not impact learner performance for SP encounters. Learners randomized to VSP first performed significantly better within VSP cases for interview (Cohen d = 0.55, P = 0.001) and treatment (Cohen d = 0.50, P = 0.043). The HVC component of learner performance on the SP simulations significantly correlated with US Medical Licensing Examination step 1 ( r = 0.26, P = 0.038) and step 2 clinical knowledge ( r = 0.33, P = 0.031). CONCLUSIONS High value care didactics combined with either VSPs or SPs positively influenced attitudes toward CCC. The ability to detect an impact of VSPs on learner SP performance was limited by content specificity and sample size.
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Affiliation(s)
- William F Bond
- From Jump Simulation (W.F.B., M.J.M., T.J.L., R.E.A., K.M.M., and M.A.), a collaboration of OSF Healthcare and the University of Illinois College of Medicine at Peoria; the Department of Internal Medicine (T.J.L., M.J.M., M.A.), Department of Pediatrics (T.J.L., M.J.M), and Department of Emergency Medicine (W.F.B) University of Illinois College of Medicine at Peoria; and Department of Medical Education (Y.S.P.), University of Illinois College of Medicine at Chicago, Chicago, IL
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System Citizenship: Re-Envisioning the Physician Role as Part of the Sixth Wave of Professionalism. Am J Med 2023; 136:596-603. [PMID: 36889491 DOI: 10.1016/j.amjmed.2023.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
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van Engen V, Bonfrer I, Ahaus K, Buljac-Samardzic M. Value-Based Healthcare From the Perspective of the Healthcare Professional: A Systematic Literature Review. Front Public Health 2022; 9:800702. [PMID: 35096748 PMCID: PMC8792751 DOI: 10.3389/fpubh.2021.800702] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Healthcare systems increasingly move toward “value-based healthcare” (VBHC), aiming to further improve quality and performance of care as well as the sustainable use of resources. Evidence about healthcare professionals' contributions to VBHC, experienced job demands and resources as well as employee well-being in VBHC is scattered. This systematic review synthesizes this evidence by exploring how VBHC relates to the healthcare professional, and vice versa.Method: Seven databases were systematically searched for relevant studies. The search yielded 3,782 records, of which 45 were eligible for inclusion based on a two-step screening process using exclusion criteria performed by two authors independently. The quality of the included studies was appraised using the Mixed Methods Appraisal Tool (MMAT). Based on inductive thematic analysis, the Job Demands-Resources (JD-R) model was modified. Subsequently, this modified model was applied deductively for a second round of thematic analysis.Results: Ten behaviors of healthcare professionals to enhance value in care were identified. These behaviors and associated changes in professionals' work content and work environment impacted the experienced job demands and resources and, in turn, employee well-being and job strain. This review revealed 16 constructs as job demand and/or job resource. Examples of these include role strain, workload and meaning in work. Four constructs related to employee well-being, including engagement and job satisfaction, and five constructs related to job strain, including exhaustion and concerns, were identified. A distinction was made between job demands and resources that were a pure characteristic of VBHC, and job demands and resources that resulted from environmental factors such as how care organizations shaped VBHC.Conclusion and Discussion: This review shows that professionals experience substantial job demands and resources resulting from the move toward VBHC and their active role therein. Several job demands are triggered by an unsupportive organizational environment. Hence, increased organizational support may contribute to mitigating or avoiding adverse psychosocial factors and enhance positive psychosocial factors in a VBHC context. Further research to estimate the effects of VBHC on healthcare professionals is warranted.
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Pahwa AK, Eaton K, Apfel A, Bertram A, Ridell R, Cayea D. Effect of a high value care curriculum on standardized patient exam in the Core Clerkship in Internal Medicine. BMC MEDICAL EDUCATION 2020; 20:365. [PMID: 33059679 PMCID: PMC7560311 DOI: 10.1186/s12909-020-02303-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/10/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND With almost 20% unnecessary spending on healthcare, there has been increasing interest in high value care defined as the best care for the patient, with the optimal result for the circumstances, delivered at the right price. The American Association of Medical Colleges recommend that medical students are proficient in concepts of cost-effective clinical practice by graduation, thus leading to curricula on high value care. However little is published on the effectiveness of these curricula on medical students' ability to practice high value care. METHODS In addition to the standard curriculum, the intervention group received two classroom sessions and three virtual patients focused on the concepts of high value care. The primary outcome was number of tests and charges for tests on standardized patients. RESULTS 136 students enrolled in the Core Clerkship in Internal Medicine and 70 completed the high value care curriculum. There were no significant differences in ordering of appropriate tests (3.1 vs. 3.2 tests/students, p = 0.55) and inappropriate tests (1.8 vs. 2.2, p = 0.13) between the intervention and control. Students in the intervention group had significantly lower median Medicare charges ($287.59 vs. $500.86, p = 0.04) and felt their education in high value care was appropriate (81% vs. 56%, p = 0.02). CONCLUSIONS This is the first study to describe the impact of a high value care curriculum on medical students' ordering practices. While number of inappropriate tests was not significantly different, students in the intervention group refrained from ordering expensive tests.
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Affiliation(s)
- Amit K Pahwa
- Division of Hospital Medicine, Division of General Pediatrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| | - Kevin Eaton
- Divsion of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Harvey 806, Baltimore, MD, 21287, USA
| | - Ariella Apfel
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 2024 East Monument Street, Baltimore, MD, 21287, USA
| | - Amanda Bertram
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Rebecca Ridell
- Office of Assessment and Evaluation, Johns Hopkins University School of Medicine, 2024 East Monument Street, Room 1-200, Baltimore, MD, 21287, USA
| | - Danelle Cayea
- Division of Geriatrics, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Easter Avenue, Mason Lord Building Center Tower Suite, Baltimore, MD, 2200, USA
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Gonzalo JD, Chang A, Dekhtyar M, Starr SR, Holmboe E, Wolpaw DR. Health Systems Science in Medical Education: Unifying the Components to Catalyze Transformation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1362-1372. [PMID: 32287080 DOI: 10.1097/acm.0000000000003400] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Medical education exists in the service of patients and communities and must continually calibrate its focus to ensure the achievement of these goals. To close gaps in U.S. health outcomes, medical education is steadily evolving to better prepare providers with the knowledge and skills to lead patient- and systems-level improvements. Systems-related competencies, including high-value care, quality improvement, population health, informatics, and systems thinking, are needed to achieve this but are often curricular islands in medical education, dependent on local context, and have lacked a unifying framework. The third pillar of medical education-health systems science (HSS)-complements the basic and clinical sciences and integrates the full range of systems-related competencies. Despite the movement toward HSS, there remains uncertainty and significant inconsistency in the application of HSS concepts and nomenclature within health care and medical education. In this Article, the authors (1) explore the historical context of several key systems-related competency areas; (2) describe HSS and highlight a schema crosswalk between HSS and systems-related national competency recommendations, accreditation standards, national and local curricula, educator recommendations, and textbooks; and (3) articulate 6 rationales for the use and integration of a broad HSS framework within medical education. These rationales include: (1) ensuring core competencies are not marginalized, (2) accounting for related and integrated competencies in curricular design, (3) providing the foundation for comprehensive assessments and evaluations, (4) providing a clear learning pathway for the undergraduate-graduate-workforce continuum, (5) facilitating a shift toward a national standard, and (6) catalyzing a new professional identity as systems citizens. Continued movement toward a cohesive framework will better align the clinical and educational missions by cultivating the next generation of systems-minded health care professionals.
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Affiliation(s)
- Jed D Gonzalo
- J.D. Gonzalo is associate professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: https://orcid.org/0000-0003-1253-2963
| | - Anna Chang
- A. Chang is professor of medicine and Gold-Headed Cane Endowed Education Chair in Internal Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Michael Dekhtyar
- M. Dekhtyar is former research associate, Medical Education Outcomes, American Medical Association, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-8548-3624
| | - Stephanie R Starr
- S.R. Starr is associate professor of pediatrics and director of science of health care delivery education, Mayo Clinic Alix School of Medicine, Rochester, Minnesota; ORCID: https://orcid.org/0000-0001-9259-3576
| | - Eric Holmboe
- E. Holmboe is chief research, milestones development, and evaluation officer, Accreditation Council for Graduate Medical Education, Chicago, Illinois, adjunct professor of medicine, Yale University, New Haven, Connecticut, and adjunct professor, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Daniel R Wolpaw
- D.R. Wolpaw is professor of medicine and humanities, Penn State University College of Medicine, Hershey, Pennsylvania
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Abstract
BACKGROUND Physicians have an opportunity to address rising health care costs by optimising resource use. Recent research suggests that regional spending patterns influence student engagement with high- and low-value behaviours, revealing that these behaviours may be adopted early in training. The major curriculum for the internal medicine clinical experience does not address high-value care (HVC). At our institution, senior medical students in the subinternship of internal medicine have an increased responsibility in the development and implementation of patient management plans. OBJECTIVE Our study aimed to determine whether a curriculum on HVC delivered to senior medical students would have a lasting impact on the students. METHODS We implemented a curriculum in HVC for medical students and surveyed them before and after the curriculum as well as prior to graduation about their perceptions and engagement with HVC practices. RESULTS We found a statistically significant increase in positive attitudes and reported perception of practice in senior medical students who received the curriculum; this was sustained prior to graduation. CONCLUSIONS Our study supports the notion that a curriculum in HVC can increase reported HVC practices. Further research should be carried out to assess the impact of efforts to teach medical students about limiting unnecessary care within our medical system.
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Affiliation(s)
- Mary Lacy
- Department of Internal Medicine, University New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Leonard Noronha
- Department of Internal Medicine, University New Mexico School of Medicine, Albuquerque, New Mexico, USA
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Roth CG, Huang W, Sekhon N, Caruso A, Kung D, Greely J, Purkiss J, Ismail N. Teaching Laboratory Stewardship in the Medical Student Core Clerkships Pathology-Teaches. Arch Pathol Lab Med 2020; 144:883-887. [PMID: 31825668 DOI: 10.5858/arpa.2019-0329-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Current health care spending is unsustainable, and there is a need to teach high-value care principles to future physicians. Pathology-Teaches is an educational intervention designed to teach laboratory stewardship early in clinical training, at the level of the medical student in their core clinical clerkships. OBJECTIVE.— To assess the pilot implementation of case-based educational modules in 5 required core clerkships at our institution. DESIGN.— The online cases were developed by using a multidisciplinary approach. In the Pathology-Teaches educational module, students make decisions regarding the ordering or interpretation of laboratory testing within the context of a clinical scenario and receive immediate feedback during the case. The intervention was assessed by using pretest and posttest. Student feedback was also collected from end-of-rotation evaluations. RESULTS.— A total of 203 students completed the Pathology-Teaches pilot, including 72 in Family Medicine, 72 in Emergency Medicine, 24 in Internal Medicine, 24 in Neurology, and 11 in Obstetrics-Gynecology (OB-GYN). Pathology-Teaches utility was demonstrated by significantly increased improvement between pretest and posttest scores (mean, 63.1% versus 83.5%; P < .001; Hedge g effect size = 0.93). Of the 494 students who completed the Pathology-Teaches questions on the end-of-rotation evaluation, 251 provided specific feedback, with 38.6% (97 of 251) rating the activity as "extremely valuable" or "very valuable," and 41.4% (104 of 251) as "some/moderate value." Qualitative feedback included 17 positive comments with 6 requests to scale up or include more cases, 16 constructive comments for improvement mainly regarding the technical aspects, and 5 negative comments. CONCLUSIONS.— Pathology-Teaches effectively teaches stewardship concepts, and most students perceived value in this educational intervention.
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Affiliation(s)
- Christine G Roth
- From the Departments of Pathology & Immunology (Dr Roth), Family Medicine (Dr Huang), Internal Medicine (Drs Caruso, Purkiss, and Ismail), Emergency Medicine (Dr Sekhon), Neurology (Dr Kung), OB-GYN, (Dr Greely), and the Office of the Curriculum (Drs Purkiss and Ismail), Baylor College of Medicine, Houston, Texas
| | - William Huang
- From the Departments of Pathology & Immunology (Dr Roth), Family Medicine (Dr Huang), Internal Medicine (Drs Caruso, Purkiss, and Ismail), Emergency Medicine (Dr Sekhon), Neurology (Dr Kung), OB-GYN, (Dr Greely), and the Office of the Curriculum (Drs Purkiss and Ismail), Baylor College of Medicine, Houston, Texas
| | - Navdeep Sekhon
- From the Departments of Pathology & Immunology (Dr Roth), Family Medicine (Dr Huang), Internal Medicine (Drs Caruso, Purkiss, and Ismail), Emergency Medicine (Dr Sekhon), Neurology (Dr Kung), OB-GYN, (Dr Greely), and the Office of the Curriculum (Drs Purkiss and Ismail), Baylor College of Medicine, Houston, Texas
| | - Andrew Caruso
- From the Departments of Pathology & Immunology (Dr Roth), Family Medicine (Dr Huang), Internal Medicine (Drs Caruso, Purkiss, and Ismail), Emergency Medicine (Dr Sekhon), Neurology (Dr Kung), OB-GYN, (Dr Greely), and the Office of the Curriculum (Drs Purkiss and Ismail), Baylor College of Medicine, Houston, Texas
| | - Doris Kung
- From the Departments of Pathology & Immunology (Dr Roth), Family Medicine (Dr Huang), Internal Medicine (Drs Caruso, Purkiss, and Ismail), Emergency Medicine (Dr Sekhon), Neurology (Dr Kung), OB-GYN, (Dr Greely), and the Office of the Curriculum (Drs Purkiss and Ismail), Baylor College of Medicine, Houston, Texas
| | - Jocelyn Greely
- From the Departments of Pathology & Immunology (Dr Roth), Family Medicine (Dr Huang), Internal Medicine (Drs Caruso, Purkiss, and Ismail), Emergency Medicine (Dr Sekhon), Neurology (Dr Kung), OB-GYN, (Dr Greely), and the Office of the Curriculum (Drs Purkiss and Ismail), Baylor College of Medicine, Houston, Texas
| | - Joel Purkiss
- From the Departments of Pathology & Immunology (Dr Roth), Family Medicine (Dr Huang), Internal Medicine (Drs Caruso, Purkiss, and Ismail), Emergency Medicine (Dr Sekhon), Neurology (Dr Kung), OB-GYN, (Dr Greely), and the Office of the Curriculum (Drs Purkiss and Ismail), Baylor College of Medicine, Houston, Texas
| | - Nadia Ismail
- From the Departments of Pathology & Immunology (Dr Roth), Family Medicine (Dr Huang), Internal Medicine (Drs Caruso, Purkiss, and Ismail), Emergency Medicine (Dr Sekhon), Neurology (Dr Kung), OB-GYN, (Dr Greely), and the Office of the Curriculum (Drs Purkiss and Ismail), Baylor College of Medicine, Houston, Texas
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Hoody DG. Capsule Commentary on Hunderfund et al., Imprinting on Clinical Rotations: Multisite Survey of High- and Low-Value Medical Student Behaviors and Relationship with Healthcare Intensity. J Gen Intern Med 2019; 34:1290. [PMID: 31011968 PMCID: PMC6614230 DOI: 10.1007/s11606-019-04905-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Daniel G Hoody
- Academic Hospital, Hennepin Healthcare, Minneapolis, MN, USA.
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