Teaching medical students about cost-effectiveness

The Effectiveness of an Interprofessional Education Course in Teaching the Importance of Choosing Wisely and Resource Stewardship: A Pilot Study

Objectives Rising health care costs and an increase in unnecessary testing have sparked interest in resource stewardship (RS) and subsequently the Choosing Wisely Canada (CWC) campaign. Currently, all Canadian medical schools have student representatives for CWC; however, the same is not true in other health professions. Interprofessional care learned through interprofessional education (IPE) can lead to better patient outcomes. This study assessed whether an IPE course for health profession students was effective in teaching undergraduate students both interprofessional competencies and CWC principles. Methods An approximately seven-hour-long, four-session course was administered to Dalhousie University health profession students (N= 30). A validated survey for IPE competencies and a general survey about CWC principles were administered to assess the course. Descriptive statistics were used to assess the general CWC views, and paired samples t-tests were employed to compare pre- and post-IPE competencies. Results The full survey was completed by 25 (83%) students. Of these, 52% were female, within five health disciplines, and 13 (52%) had heard of CWC prior. Overall, the students agreed that CWC was important and relevant to their profession. They also reported significant improvements in multiple IPE competencies, including communication, collaboration, roles and responsibilities, patient-/family-centered care, conflict management/resolution, and team function. Conclusion Participants in our pilot Choosing Wisely IPE course valued the importance of the CWC campaign and reported improvement in multiple IPE competencies. This adaptable, simple, and low-cost course may be an effective way to integrate RS teaching across multiple health professions.

Applying High-Value Care Principles in a Pediatric Case: A Workshop for Health Professions Students

INTRODUCTION

The cost of health care in the US is rapidly rising. Understanding the financial cost of medical care is an important competency for physicians and physicians-in-training. Medical students in their clinical clerkships are being exposed to health care decision-making often for the first time and are forming habits they will carry throughout their training and careers. Teaching high-value care (HVC) principles is crucial for students as they will be the future leaders in health care.

METHODS

This 1-hour workshop was interactive and aimed to prepare medical students to apply HVC when making medical decisions. The topic of HVC was initially introduced by eliciting tests that students want to order and highlighting the concept of whether or not a test changes the management of the patient. This exercise was followed by a PowerPoint presentation which discussed HVC, Choosing Wisely guidelines in pediatrics, and how to communicate with parents and patients about this topic.

RESULTS

Of third-year medical students, 125 participated in the workshop, with a survey response rate of 90% (n = 112). Ninety-nine percent reported that this workshop was helpful, and 97% reported that they will change their practice to reflect more cost-conscious care. Most students reported that their knowledge of HVC improved after the session, with 88% reporting scores of 3 (moderately improved) or 4 (significantly improved).

DISCUSSION

This ready-to-implement workshop offered students an understanding of how the cost of medical care impacts patients and families and how to practice cost-conscious care in pediatrics.

Novel first-year curriculum in high-value care

BACKGROUND

Most medical schools teach a high-value care (HVC) curriculum during the clinical years. Currently, there lacks any research demonstrating the effectiveness of the HVC curriculum taught to students in their first year of medical school.

METHODS

A total of 118 of 466 first-year medical students at Johns Hopkins School of Medicine between 2013 and 2017 enrolled on an HVC course that provided the initial framework necessary to practice cost-conscious clinical medicine. The curriculum was evaluated by comparing the performance of students who completed the course with the performance of students without training, through a standardised patient encounter on musculoskeletal back pain and how to approach a patient's request for imaging. Chi-square testing was used to assess the impact of the course on performance in a standardised patient encounter.

RESULTS

Students enrolled on the HVC course were more likely, compared with their counterparts, to assure patients that back pain was a simple strain (48 versus 31%), and were less likely to ask for preceptor help on how to proceed with management (11 versus 29%) [χ² (4, n = 466) = 14.28, p = 0.007]. There were no differences between students enrolled on the HVC course who had not yet received training compared with students taking another elective [χ² (4, n = 385) = 8.73, p = 0.07].

DISCUSSION

This is the first study to assess the effectiveness of an HVC curriculum for first-year medical students, and it demonstrates promise that they can acquire some skill sets necessary for cost-effective practice in a simulated clinical setting. This is the first study to assess the effectiveness of an HVC curriculum for first-year medical students, and it demonstrates promise that they can acquire some skill sets necessary for cost-effective practice.

Evaluation and Countermeasures of the Implementation of the Lake Protection and Governance System in Wuhan City, Middle China

The protection and management of lakes is closely related to people’s quality of life and the rapid development of urban economy, and it is also an important aspect of realizing ecological sustainability. Hubei Province has over 1000 lakes, so the importance of the protection and governance of lakes is self-evident. Since the Lake Protection Regulations of Hubei Province came into being, Hubei Province has achieved the gradual extension and improvement of the system of responsibility for the protection of the lake. In order to understand the development of the system of responsibility for the protection of the lake and to explore the shortcomings in the implementation of the lake management system, this paper takes Wuhan city, capital of Hubei Province, as an example, as the object of research and evaluates the implementation effect of the lake protection mechanism and system after the promulgation of Hubei Province Lake Protection Regulations. According to the evaluation results, since the implementation of the regulations, the formal protection of lakes in Wuhan city has been promoted step by step, and the effect of lake management has also been remarkable. The government attaches great importance to lake protection, and the enthusiasm of government staff participating in this is increasing. However, the evaluation results also reveal some weaknesses of the current system of lake protection and governance, including the protection of lake quality, the perfection of the annual appraisal system and the administrative responsibility system, and the optimization of the lake garbage disposal system. On the basis of the results, this paper puts forward countermeasures and ideas to perfect the mechanism and system of lake protection and management in Wuhan city, in order to provide reference for the lake protection and management in other areas.