Effect of a high value care curriculum on standardized patient exam in the Core Clerkship in Internal Medicine.
Effect of a high value care curriculum on standardized patient exam in the Core Clerkship in Internal Medicine.
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DOI：
10.1186/s12909-020-02303-1
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发表时间：
2020-10-15
影响因子：
3.6
通讯作者：
Cayea D
中科院分区：
文献类型：
--
作者：
Pahwa AK;Eaton K;Apfel A;Bertram A;Ridell R;Cayea D
由于近20%的不必要医疗支出，人们对高价值医疗越来越感兴趣，高价值医疗被定义为为患者提供最佳护理，并以合适的价格提供针对情况的最佳结果。美国医学院协会建议医学生在毕业时精通具有成本效益的临床实践的概念，从而开设高价值护理课程。然而，关于这些课程对医学生实践高价值护理能力的有效性的报道很少。除了标准课程外，干预组还接受了两次课堂会议和三名虚拟患者，他们专注于高价值护理的概念。主要结果是标准化患者的测试次数和测试费用。136名学生参加了内科核心助理课程，70名学生完成了高价值护理课程。干预组和对照组在适当测试顺序(3.1vs.3.2测试/学生，p = 0.55)和不适当测试顺序(1.8vs.2.2，p = 0.13)方面没有显著差异。干预组学生的医疗保险费用中位数显著较低(287.59美元对500.86美元，p = 0.04)，并认为他们的高价值护理教育是适当的(81%对56%，p = 0.02)。这是第一次描述高价值护理课程对医学生点餐实践的影响的研究。虽然不适当测试的数量没有显著差异，但干预组的学生避免订购昂贵的测试。
With 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. In 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. 136 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). This 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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影响因子：
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