Blogger: Snigdha Jain, MD
About the blogger: Snigdha Jain, MD is an Assistant Professor of Medicine at the UT Southwestern Medical Center. She completed a Certificate in Medical Education through the University of Iowa Carver College of Medicine alongside her internal medicine residency training. She is interested in graduate medical education with a particular focus on critical care and inpatient medicine.
Citation: Stammen LA, Stalmeijer RE, Paternotte E, Oudkerk Pool A, Driessen EW, Scheele F, Stassen LP. Training Physicians to Provide High-Value, Cost-Conscious Care: A Systematic Review. JAMA. 2015 Dec 8;314(22):2384-400.
Why this article?
With rising healthcare expenditures, high value care is gaining momentum across medical specialties including critical care medicine. Since physician choices of diagnostic and treatment measures are responsible for a substantial portion of this cost, educating future generations of physicians at both graduate and undergraduate levels becomes important. This article systematically reviewed educational interventions targeted at achieving cost conscious care.
The authors screened more than 2500 articles for studies of any design that described an educational intervention on medical students, residents or physicians and evaluated its impact on improving knowledge/ attitude regarding cost of care, improving quality of care, reducing healthcare expenditure or reducing volume of health care services, with no date restrictions. They included 79 studies in the systematic review and described 3 core principles that led to successful learning:
- Knowledge transmission - specifically including knowledge on general health economics, evidence based medicine and understanding patient preferences;
- Reflective practice - by providing feedback on cost, volume and appropriateness of testing or prescriptions, asking reflective questions and combination of the two; and
- Supportive environment - with cultivation of a culture of high value care.
As an educator, my day-to-day teaching is largely focused on diagnostic reasoning and evidence-based management with principles of high value care usually seeping in through role modeling and scattered example cases. By laying out specific strategies to address, this article helps educators and institutions consciously tailor their efforts towards furthering high value care by incorporating literature on cost conscious care in what they teach, asking specific feedback questions about test ordering and prescribing practices and creating a supportive environment for such discussions. Importantly, it also highlights the need for objectivity and uniformity in the assessment of educational interventions to allow pooling of data to generate higher levels of evidence for our practices.
