Medical Students' Observations of High Value and Potentially Wasteful Care Behaviors Modeled During Clinical Rotations

被引:1
作者
Wade, Amanda [1 ]
Kalkat, Meher [2 ]
Uyeki, Colin [3 ]
Arora, Neha [4 ]
Stachowski, Jill [5 ]
Gullborg, Eric [6 ]
Demetriou, Nicholas [7 ]
Haridhas, Anuradha [8 ]
Giberson, Scott [9 ]
Khan, Anwar Ahmed [10 ]
Choudhary, Nikita [11 ]
Milman, Robert [4 ]
Latimer, Kelly [6 ]
Mcgillen, Brian
Bell, Amanda [8 ]
Olm-Shipman, Casey [9 ]
Selinger, Howard [3 ]
Niranjan-Azadi, Ashwini [2 ]
Agrawal, Rishi [7 ]
Appelbaum, Jonathan [10 ]
Moriates, Christopher [12 ,13 ,15 ]
Carney, Patricia A. [1 ]
Smeraglio, Andrea [1 ,14 ]
机构
[1] Oregon Hlth & Sci Univ, Sch Med, Portland, OR 97239 USA
[2] Johns Hopkins Sch Med, Baltimore, MD USA
[3] Frank H Netter Sch Med, North Haven, CT USA
[4] Texas A&M Sch Med, Bryan, TX USA
[5] Penn State Coll Med, Hershey, PA USA
[6] Eastern Virginia Med Sch, Norfolk, VA USA
[7] Northwestern Univ, Feinberg Sch Med, Chicago, IL USA
[8] Wright State Univ, Boonshoft Sch Med, Dayton, OH USA
[9] Univ North Carolina, Sch Med, Chapel Hill, NC USA
[10] Florida State Univ, Coll Med, Tallahassee, FL USA
[11] Univ Texas Austin, Med Sch, Austin, TX USA
[12] Vet Adm Greater Los Angeles Healthcare Syst, Los Angeles, CA USA
[13] Univ Calif Los Angeles, Dept Med, Los Angeles, CA USA
[14] US Vet Adm Portland Oregon, Portland, OR USA
[15] Costs Care, Cambridge, MA USA
关键词
high-value care; high-value cost-conscious care; undergraduate medical education; HVC; COST-CONSCIOUS CARE; HEALTH-CARE; PHYSICIANS; PERCEPTIONS; INTENSITY;
D O I
10.1007/s11606-024-09322-4
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
BackgroundMedical student exposure to role-modeling of high-value care (HVC) behaviors may shape professional identity formation and future HVC practices.ObjectiveTo investigate the frequency and characteristics of HVC role-modeling witnessed by medical students during core clinical rotations.DesignCross-sectional survey study.ParticipantsMedical students on clinical rotations at 11 US medical schools.Main MeasuresA validated 13-item survey was used to assess medical student perception of cost-conscious role-modeling behaviors or potentially wasteful role-modeling behaviors and modified to include whom demonstrated the behavior (attending vs resident/fellow) and during which clinical rotation the modeling occurred.Key ResultsCost-conscious role-modeling behaviors were observed by medical students sometimes/often 52.9-70.5% (353/667-452/641) of the time across all clinical rotations, except for praising a student for ordering a cost-effective diagnostic work-up which was seen only 25.7% (143/556) of the time. Potentially wasteful role-modeling behaviors were observed sometimes/often 5-14.3% (26/537-87/609) of the time, except simultaneously ordering numerous tests before seeing results of initial screening tests 45.1% (273/605) and repeating tests rather than attempting to obtain recently performed test results 32.2% (194/602). HVC modeling was most often demonstrated by internal medicine attendings 67.7% (65/96) and least frequently by general surgery attendings 47.3% (17/36). Attendings were overall more likely to model HVC compared to residents/fellows.ConclusionHVC role-modeling, as observed by medical students, is not consistently demonstrated across clinical rotations. Attendings generally model more HVC than residents and general surgery models less HVC compared to other specialties. Future studies should strive to identify factors which promote or inhibit HVC modeling.
引用
收藏
页码:1758 / 1767
页数:10
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