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Anderson ML, Beltran CP, Harnik V, Atkins M, Corral J, Farina G, Fornari A, Hamburger M, Holliday S, Manko J, Normand K, Ownby A, Pfeil S, Rankin D, Cohen A, Schwartzstein RM, Hayes MM. A multisite randomized trial of implicit versus explicit modeling in clinical teaching. MEDICAL TEACHER 2022; 45:1-8. [PMID: 36302061 DOI: 10.1080/0142159x.2022.2133691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Faculty modeling of desired behaviors has historically been a part of the apprenticeship model of clinical teaching, yet little is known about best practices for modeling. This study compared the educational impact of implicitly versus explicitly modeled communication skills among U.S. medical students. METHOD Fourth-year medical students from six U.S. academic medical centers were randomly assigned one simulated clinical encounter in which faculty provided either implicit or explicit modeling of important communication skills. Outcomes were assessed by electronic surveys immediately before and after the simulations. Students were blinded to the purpose of the study. RESULTS Students in the explicit arm were more likely to correctly cite two of the three key specific communication elements modeled by faculty: deliberate body position (53.3% vs. 18.6%, p < 0.001) and summarizing patient understanding (62.2% vs. 11.6%, p < 0.001). More students in the explicit study arm reported faculty 'demonstrated a key behavior that they wanted me to be able to perform in the future' (93.2% versus 62.8%, p = 0.002). Participating faculty stated they would modify their teaching approach in response to their experiences in the study. CONCLUSIONS In a multi-center randomized trial, explicit faculty role-modeling led to greater uptake of communication knowledge, greater recognition of skills, and a greater sense that faculty expected these skills to be adopted by students. These results must be considered in the context, however, of a simulated environment and a short timeframe for assessing learning with students who volunteered for a simulated experience.
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Affiliation(s)
- Mel L Anderson
- Department of Medicine, University of Colorado School of Medicine and Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Christine P Beltran
- Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Victoria Harnik
- New York University Grossman School of Medicine, New York, NY, USA
| | | | - Janet Corral
- University of Arizona College of Medicine Tucson, Tucson, AZ, USA
| | - Gino Farina
- The Donald and Barbara Zucker School of Medicine Hofstra/Northwell, Hempstead, NY, USA
| | - Alice Fornari
- The Donald and Barbara Zucker School of Medicine Hofstra/Northwell, Hempstead, NY, USA
| | | | - Scott Holliday
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jeff Manko
- New York University Grossman School of Medicine, New York, NY, USA
| | - Katherine Normand
- McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Alisson Ownby
- McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Sheryl Pfeil
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Demicha Rankin
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Amy Cohen
- New York University Grossman School of Medicine, New York, NY, USA
- Harvard Chan School of Public Health, Boston, MA, USA
| | - Richard M Schwartzstein
- Carl J. Shapiro Institute for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Ricotta DN, Richards JB, Atkins KM, Hayes MM, McOwen K, Soffler MI, Tibbles CD, Whelan AJ, Schwartzstein RM. Self-Directed Learning in Medical Education: Training for a Lifetime of Discovery. TEACHING AND LEARNING IN MEDICINE 2022; 34:530-540. [PMID: 34279167 DOI: 10.1080/10401334.2021.1938074] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
Issue: Life-long learning is a skill that is central to competent health professionals, and medical educators have sought to understand how adult professionals learn, adapt to new information, and independently seek to learn more. Accrediting bodies now mandate that training programs teach in ways that promote self-directed learning (SDL) but do not provide adequate guidance on how to address this requirement. Evidence: The model for the SDL mandate in physician training is based mostly on early childhood and secondary education evidence and literature, and may not capture the unique environment of medical training and clinical education. Furthermore, there is uncertainty about how medical schools and postgraduate training programs should implement and evaluate SDL educational interventions. The Shapiro Institute for Education and Research, in conjunction with the Association of American Medical Colleges, convened teams from eight medical schools from North America to address the challenge of defining, implementing, and evaluating SDL and the structures needed to nurture and support its development in health professional training. Implications: In this commentary, the authors describe SDL in Medical Education, (SDL-ME), which is a construct of learning and pedagogy specific to medical students and physicians in training. SDL-ME builds on the foundations of SDL and self-regulated learning theory, but is specifically contextualized for the unique responsibilities of physicians to patients, inter-professional teams, and society. Through consensus, the authors offer suggestions for training programs to teach and evaluate SDL-ME. To teach self-directed learning requires placing the construct in the context of patient care and of an obligation to society at large. The SDL-ME construct builds upon SDL and SRL frameworks and suggests SDL as foundational to health professional identity formation.KEYWORDSself-directed learning; graduate medical education; undergraduate medical education; theoretical frameworksSupplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1938074 .
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Affiliation(s)
- Daniel N Ricotta
- Carl J. Shapiro Center for Education and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy B Richards
- Carl J. Shapiro Center for Education and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - K Meredith Atkins
- Carl J. Shapiro Center for Education and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret M Hayes
- Carl J. Shapiro Center for Education and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine McOwen
- Association of American Medical Colleges, Washington, District of Columbia, USA
| | - Morgan I Soffler
- Carl J. Shapiro Center for Education and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Carrie D Tibbles
- Carl J. Shapiro Center for Education and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alison J Whelan
- Association of American Medical Colleges, Washington, District of Columbia, USA
| | - Richard M Schwartzstein
- Carl J. Shapiro Center for Education and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Ginzburg SB, Hayes MM, Ranchoff BL, Aagaard E, Atkins KM, Barnes M, Soep JB, Yacht AC, Alexander EK, Schwartzstein RM. Optimizing allocation of curricular content across the Undergraduate & Graduate Medical Education Continuum. BMC MEDICAL EDUCATION 2022; 22:425. [PMID: 35655308 PMCID: PMC9161628 DOI: 10.1186/s12909-022-03489-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Medical educators struggle to incorporate socio-cultural topics into crowded curricula. The "continuum of learning" includes undergraduate and graduate medical education. Utilizing an exemplar socio-cultural topic, we studied the feasibility of achieving expert consensus among two groups of faculty (experts in medical education and experts in social determinants of health) on which aspects of the topic could be taught during undergraduate versus graduate medical education. METHODS A modified Delphi method was used to generate expert consensus on which learning objectives of social determinants of health are best taught at each stage of medical education. Delphi respondents included experts in medical education or social determinants of health. A survey was created using nationally published criteria for social determinants of health learning objectives. Respondents were asked 1) which learning objectives were necessary for every physician (irrespective of specialty) to develop competence upon completion of medical training and 2) when the learning objective should be taught. Respondents were also asked an open-ended question on how they made the determination of when in the medical education continuum the learning objective should be taught. RESULTS 26 out of 55 experts (13 social determinants of health and 13 education experts) responded to all 3 Delphi rounds. Experts evaluated a total of 49 learning objectives and were able to achieve consensus for at least one of the two research questions for 45 of 49 (92%) learning objectives. 50% more learning objectives reached consensus for inclusion in undergraduate (n = 21) versus graduate medical education (n = 14). CONCLUSIONS A modified Delphi technique demonstrated that experts could identify key learning objectives of social determinants of health needed by all physicians and allocate content along the undergraduate and graduate medical education continuum. This approach could serve as a model for similar socio-cultural content. Future work should employ a qualitative approach to capture principles utilized by experts when making these decisions.
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Affiliation(s)
- Samara B Ginzburg
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Margaret M Hayes
- Medical Intensive Care Unit, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School in Boston, Boston, MA, USA
| | - Brittany L Ranchoff
- Beth Israel Deaconess Medical Center, Boston, MA, USA
- University of Massachusetts, Amherst, MA, USA
| | - Eva Aagaard
- Washington University School of Medicine, St. Louis, MO, USA
| | - Katharyn M Atkins
- Harvard Medical School in Boston, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michelle Barnes
- Clinical pediatrics and internal medicine University of Illinois College of Medicine, Chicago, IL, USA
| | | | - Andrew C Yacht
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Erik K Alexander
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Richard M Schwartzstein
- Medicine and Medical Education, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Noben CYG, Stammen LA, Vaassen S, Haeren R, Stassen L, Mook WV, Essers B. Discrete choice experiment on educating value-based healthcare. Postgrad Med J 2020; 97:515-520. [PMID: 32796111 DOI: 10.1136/postgradmedj-2019-137190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/19/2020] [Accepted: 06/20/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Identifying costs and values in healthcare interventions as well as the ability to measure and consider costs relative to value for patients are pivotal in clinical decision-making and medical education. This study explores residents' preferences in educating value-based healthcare (VBHC) during postgraduate medical education. Exploring residents' preferences in VBHC education, in order to understand what shapes their choices, might contribute to improved medical residency education and healthcare as a whole. METHODS A discrete choice experiment (DCE) examined which conditions for educating VBHC are preferred by residents. DCE gives more insight into the trade-off's residents make when choosing alternatives, and which conditions for educating VBHC have the most influence on residents' preference. RESULTS This DCE shows that residents prefer knowledge on both medical practice as well as the process of care-to be educated by an expert on VBHC together with a clinician. They prefer limited protected time to conduct VBHC initiatives (thus while at work) and desire the inclusion of VBHC in formal educational plans. CONCLUSION When optimising graduate and postgraduate medical education curricula, these preferences should be considered to create necessary conditions for the facilitation and participation of residents in VBHC education and the set-up of VBHC initiatives.
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Affiliation(s)
- Cindy Y G Noben
- Academy of Postgraduate Medical Education, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Lorette A Stammen
- Department of Educational Development and Research, Maastricht University - Location Randwyck, Maastricht, Netherlands
| | - Sanne Vaassen
- Pediatrics, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Roel Haeren
- Neurosurgery, Maastricht University Medical Centre+, Maastricht, Netherlands.,Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Laurents Stassen
- Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands.,Department of Educational Development and Research, Maastricht University, Maastricht, Netherlands
| | - Brigitte Essers
- Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, Netherlands
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Manja V, Monteiro S, You J, Guyatt G, Lakshminrusimha S, Jack SM. Incorporating content related to value and cost-considerations in clinical decision-making: enhancements to medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:751-766. [PMID: 31144075 DOI: 10.1007/s10459-019-09896-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 05/07/2019] [Indexed: 06/09/2023]
Abstract
Although incorporating cost-considerations during healthcare decision-making is increasingly important to American patients and physicians, content related to these constructs is not routinely included in medical education. As a result, physicians are ill-equipped to consider costs. This study sought input from practicing physicians on perceived deficiencies in current teaching and recommendations for necessary content to include in medical teaching. We conducted a qualitative descriptive study using semi-structured interviews utilizing a purposeful maximum variation sample of cardiologists and neonatologists practicing in diverse settings. We analyzed interviews using conventional content analysis. 18 cardiologists and 17 neonatologists participated in this study. Respondents perceived that current teaching does not impart sufficient knowledge of value and cost considerations to achieve patient-centered, high-value decision-making. They identified the following priority areas for education related to healthcare costs: the business of medicine and information about out-of-pocket patient costs, training in health research interpretation skills to critically appraise evidence, and communication skills to engage patients as partners in shared decision-making. Participants recommended a variety of teaching methods, including didactic sessions on core topics, role modeling and case studies. American physicians perceive learning needs related to the incorporation of costs into clinical decision-making that can inform curriculum development initiatives in this field. Physicians perceive knowledge of these topics and skills to be crucial to achieving patient-centered high-value care. Concomitant health system reforms supporting the needs of the patient at its center are essential to enable physicians to focus on a patient-centered approach to healthcare delivery.
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Affiliation(s)
- Veena Manja
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
- Department of Surgery, University of California Davis, 2335 Stockton Blvd., Sacramento, CA, 95817, USA.
- Department of Medicine, Department of Veterans Affairs, Northern California Health Care System, Mather, CA, 95655, USA.
| | - Sandra Monteiro
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - John You
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Susan M Jack
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Perez R, Aizenberg D, Davis T, Ryskina KL. Seeking a stable foundation to build on: 1 st-Year residents' views of high-value care teaching. EDUCATION FOR HEALTH (ABINGDON, ENGLAND) 2019; 32:11-17. [PMID: 31512587 DOI: 10.4103/efh.efh_189_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND United States (US) residency programs have been recently mandated to teach the concept of high-value care (HVC) defined as care that balances the benefits of interventions with their harms and costs. We know that reflective practice is a key to successful learning of HVC; however, little is known about resident perceptions of HVC learning. To better inform HVC teaching in graduate medical education, we asked 1st-year residents to reflect on their HVC learning. METHODS We conducted three focus groups (n = 36) and online forum discussion (n = 13) of 1st-year internal medicine residents. A constructivist grounded theory approach was used to assess transcripts for recurrent themes to identify the perspectives of residents shared about HVC learning. RESULTS Residents perceived their learning of HVC as limited by cultural and systemic barriers that included limited time, fear of missing a diagnosis, perceived expectations of attending physicians, and poor cost transparency. While the residents reported considerable exposure to the construct of HVC, they desired a more consistent framework that could be applied in different situations. In particular, residents reported frustration with variable incentives, objectives, and definitions pertaining to HVC. Suggestions for improvement in HVC teaching outlined three main needs for: (1) a generalizable framework to systematically approach each case that could be later adapted to independent practice; (2) objective real-time data on costs, benefits, and harms of medical interventions; and (3) standardized approach to assess resident competency in HVC. DISCUSSION As frontline clinicians and the intended target audience for HVC education, 1st-year residents are in a unique position to provide feedback to improve HVC teaching in residency. Our findings highlight the learners' desire for a more systematic approach to HVC teaching that includes the development of a stable generalizable framework for decision-making, objective data, and standardized assessment. These findings contrast current educational interventions in HVC that aim at reducing the overuse of specific practices.
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Affiliation(s)
- Rey Perez
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David Aizenberg
- Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Trocon Davis
- Department of Family Medicine and Community Health, Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Kira L Ryskina
- Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Ryskina KL, Smith CD, Arora VM, Zaas AK, Halvorsen AJ, Weissman A, Wahi-Gururaj S. Relationship Between Institutional Investment in High-Value Care (HVC) Performance Improvement and Internal Medicine Residents' Perceptions of HVC Training. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1517-1523. [PMID: 29697425 PMCID: PMC6442932 DOI: 10.1097/acm.0000000000002257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To measure the association between institutional investment in high-value care (HVC) performance improvement and resident HVC experiences. METHOD The authors analyzed data from two 2014 surveys assessing institutions' investments in HVC performance improvement as reported by program directors (PDs) and residents' perceptions of the frequency of HVC teaching, participation in HVC-focused quality improvement (QI), and views on HVC topics. The authors measured the association between institutional investment and resident-reported experiences using logistic regression, controlling for program and resident characteristics. RESULTS The sample included 214 programs and 9,854 residents (59.3% of 361 programs, 55.2% of 17,851 residents surveyed). Most PDs (158/209; 75.6%) reported some support. Residents were more likely to report HVC discussions with faculty at least a few times weekly if they trained in programs that offered HVC-focused faculty development (odds ratio [OR] = 1.19; 95% confidence interval [CI] 1.04-1.37; P = .01), that supported such faculty development (OR = 1.21; 95% CI 1.04-1.41; P = .02), or that provided physician cost-of-care performance data (OR = 1.19; 95% CI 1.03-1.39; P = .02). Residents were more likely to report participation in HVC QI if they trained in programs with a formal HVC curriculum (OR = 1.83; 95% CI 1.48-2.27; P < .001) or with HVC-focused faculty development (OR = 1.46; 95% CI 1.15-1.85; P = .002). CONCLUSIONS Institutional investment in HVC-related faculty development and physician feedback on costs of care may increase the frequency of HVC teaching and resident participation in HVC-related QI.
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Affiliation(s)
- Kira L Ryskina
- K.L. Ryskina is assistant professor of medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0003-3379-6394. C.D. Smith is vice president, Clinical Programs, American College of Physicians, and adjunct associate professor of medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-1910-9546. V.M. Arora is associate professor and director, Graduate Medical Education Clinical Learning Environment Innovation, Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-4745-7599. A.K. Zaas is associate professor, Division of Infectious Diseases and International Health, and program director, Duke Internal Medicine Residency, Duke University School of Medicine, Duke University, Durham, North Carolina. A.J. Halvorsen is assistant professor of medicine, Office of Educational Innovations, Internal Medicine Residency Program, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-1272-616X. A. Weissman is director, Research Center, American College of Physicians, Philadelphia, Pennsylvania. S. Wahi-Gururaj is associate professor of medicine, Section of General Internal Medicine, and program director, Internal Medicine Residency, Department of Internal Medicine, University of Nevada, Las Vegas School of Medicine, Las Vegas, Nevada
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Ryskina KL, Holmboe ES, Shea JA, Kim E, Long JA. Physician Experiences With High Value Care in Internal Medicine Residency: Mixed-Methods Study of 2003-2013 Residency Graduates. TEACHING AND LEARNING IN MEDICINE 2018; 30:57-66. [PMID: 28753038 PMCID: PMC5803790 DOI: 10.1080/10401334.2017.1335207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Phenomenon: High healthcare costs and relatively poor health outcomes in the United States have led to calls to improve the teaching of high value care (defined as care that balances potential benefits of interventions with their harms including costs) to physicians-in-training. Numerous interventions to increase high value care in graduate medical education were implemented at the national and local levels over the past decade. However, there has been little evaluation of their impact on physician experiences during training and perceived preparedness for practice. We aimed to assess trends in U.S. physician experiences with high value care during residency over the past decade. APPROACH This mixed-methods study used a cross-sectional survey mailed July 2014 to January 2015 to 902 internists who completed residency in 2003-2013, randomly selected from the American Medical Association Masterfile. Quantitative analyses of survey responses and content analysis of free-text comments submitted by respondents were performed. FINDINGS A total of 456 physicians (50.6%) responded. Fewer than one fourth reported being exposed to teaching about high value care at least frequently (23.6%, 106/450). Only 43.8% of respondents (193/446) felt prepared to use overtreatment guidelines in conversations with patients, whereas 85.8% (379/447) felt prepared to participate in shared decision making with patients at the conclusion of their training, and 84.4% (380/450) reported practicing generic prescribing. Physicians who completed residency more recently were more likely to report practicing generic prescribing and feeling well prepared to use overtreatment guidelines in conversations with patients (p < .01 for both). Insights: In a national survey, recent U.S. internal medicine residency graduates were more likely to experience high value care during training, which may reflect increased national and local efforts in this area. However, being exposed to high value care as a trainee may not translate into specific tools for practice. In fact, many U.S. internists reported inadequate exposure to prepare them for patient discussions about costs and the use of overtreatment guidelines in practice.
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Affiliation(s)
- Kira L Ryskina
- a Division of General Internal Medicine , Perelman School of Medicine of the University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Eric S Holmboe
- b Accreditation Council for Graduate Medical Education , Chicago , Illinois , USA
| | - Judy A Shea
- a Division of General Internal Medicine , Perelman School of Medicine of the University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Esther Kim
- a Division of General Internal Medicine , Perelman School of Medicine of the University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Judith A Long
- a Division of General Internal Medicine , Perelman School of Medicine of the University of Pennsylvania , Philadelphia , Pennsylvania , USA
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Moser EM, Fazio SB, Packer CD, Glod SA, Smith CD, Alguire PC, Huang GC. SOAP to SOAP-V: A New Paradigm for Teaching Students High Value Care. Am J Med 2017; 130:1331-1336.e2. [PMID: 28778492 DOI: 10.1016/j.amjmed.2017.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/28/2017] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | | | - Cynthia D Smith
- American College of Physicians, Philadelphia, Pa; University of Pennsylvania, Philadelphia
| | - Patrick C Alguire
- American College of Physicians, Philadelphia, Pa; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pa
| | - Grace C Huang
- Harvard Medical School, Boston, Mass; Carl J. Shapiro Institute for Education and Research at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass
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Iscoe M, Lord R, Schulz J, Lee D, Cayea D, Pahwa A. Teaching medical students about cost-effectiveness. CLINICAL TEACHER 2017; 15:24-28. [PMID: 28322509 DOI: 10.1111/tct.12613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rising and burdensome health care costs have driven interest in the practice of high-value care (HVC) and have inspired calls for increased HVC training across all levels of medical education, including among undergraduate medical students. CONTEXT Classroom-based HVC curricula targeted to medical students have not been previously described in the medical literature. INNOVATION We developed and evaluated a workshop comprising a lecture, a small-group exercise and a group discussion to instruct medical students on interpreting cost-effectiveness analyses (CEA), applying CEA to patient care and discussing the cost of care with patients. From January 2014 to September 2015 the workshop was administered to five cohorts, 120 students in total, in the internal medicine clerkships at two US medical schools. Pre- and post-intervention confidence in various domains was assessed with a Likert-type scale ranging from 1 to 4. The overall response rate was 87.9 per cent. The proportion of students reporting high confidence scores (3 or 4) rose significantly (p < 0.01) in each domain: from 16.2 to 76.9 per cent for calculating an incremental cost-effectiveness ratio (ICER); from 16.0 to 79.6 per cent for interpreting quality-adjusted life-years (QALYs); from 8.7 to 71.3 per cent for using CEA in patient management; and from 15.3 to 71.4 per cent for discussing costs with patients. Students rated the overall quality of the course as 3.82 out of 5. Rising and burdensome health care costs have driven interest in the practice of high-value care IMPLICATIONS: Our experience of developing, evaluating and refining an HVC course targeted at medical students taught us that such a course is needed, can be educational and can be well-received. Future research is needed to assess the effects of curricula on clinical practice.
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Affiliation(s)
- Mark Iscoe
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Robert Lord
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - John Schulz
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - David Lee
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Danelle Cayea
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Amit Pahwa
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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