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Effect of a high value care curriculum on standardized patient exam in the Core Clerkship in Internal Medicine

Authors
  • Pahwa, Amit K.1
  • Eaton, Kevin2
  • Apfel, Ariella3
  • Bertram, Amanda4
  • Ridell, Rebecca5
  • Cayea, Danelle6
  • 1 Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA , Baltimore (United States)
  • 2 Johns Hopkins University School of Medicine, 600 North Wolfe Street, Harvey 806, Baltimore, MD, 21287, USA , Baltimore (United States)
  • 3 Johns Hopkins University School of Medicine, 2024 East Monument Street, Baltimore, MD, 21287, USA , Baltimore (United States)
  • 4 Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA , Baltimore (United States)
  • 5 Johns Hopkins University School of Medicine, 2024 East Monument Street, Room 1-200, Baltimore, MD, 21287, USA , Baltimore (United States)
  • 6 Johns Hopkins University School of Medicine, 5200 Easter Avenue, Mason Lord Building Center Tower Suite, Baltimore, MD, 2200, USA , Baltimore (United States)
Type
Published Article
Journal
BMC Medical Education
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Oct 15, 2020
Volume
20
Issue
1
Identifiers
DOI: 10.1186/s12909-020-02303-1
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundWith 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.MethodsIn 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.Results136 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).ConclusionsThis 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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