Choosing Wisely STARS: Teaching Value in Medical Education and the Broader Community

From the 2019 HVPAA National Conference

Ms. Sarah Follman (Pritzker School of Medicine), Mr. Rahul Dadwani (Pritzker School of Medicine), Ms. Gena Lenti (Pritzker School of Medicine), Dr. Vineet Arora (Pritzker School of Medicine)

Background

Healthcare costs in the United States are rising and an estimated 45% of healthcare today is “low-value” or wasteful. Thus, it is crucial that medical schools incorporate education about value into curricula. At the University of Chicago, we piloted an elective to train first-year medical students in principles of value-based medicine, in-line with the mission of the Choosing Wisely initiative of the American Board of Internal Medicine Foundation. Students in the elective served as ambassadors of value. In this course, medical students hosted workshops for their peers and events for community-members centered around the theme of value-based healthcare.

Objective

To develop an elective for MS1s centered around Choosing Wisely principles of high-value care.

Methods

Our programming consisted of two components: a curricular intervention and student-led initiatives.

Curricular Intervention

We implemented an elective for first-year medical students called Teaching Value. We incorporated tools from the Choosing Wisely Initiative.

Student-led initiatives

To promote knowledge about value amongst peers, students created an identification (ID) badge card. Students distributed the badge cards in school-wide workshops. The second initiative included a Community Grand Rounds (CGR). This event sought to increase community knowledge about low-value care and promote familiarity with cost-related resources. We assessed these interventions with a before/after survey and a paired Wilcoxon rank-sum test to compare responses.

Results

Students who attended the workshop reported a significant increase (n=20; p<0.01) in familiarity/confidence in the following:

  • I am familiar with the Choosing Wisely (CW) initiative and the principles of value-based care
  • I feel confident in my abilities to access resources regarding high-value procedures and practices
  • I feel confident in my ability to apply CW principles to the bed side through my role as a student.

Community members who attended the CGR event reported a significant increase (n=32; p<0.01) in the following:

  •  I feel confident talking to my healthcare provider about issues regarding costs of care
  • I am aware of resources that I can access when I have difficulty paying my healthcare bills
  • I am aware of ways I can lower the costs of my medications
  • I am aware of the Choosing Wisely Initiative and how I can seek value-based care as a patient.

Conclusions

This study found student-led initiatives to be successful in increasing familiarity with value in medicine, the CW initiative, and cost-related resources. These findings support previous studies which found that 82% of student-led campaigns to be successful in implementing change at their respective medical schools. Future research should examine the effect of similar initiatives on medical students and their willingness to apply value in their future practice.

Clinical Implications

Our analysis found both of our student-led initiatives were successful in increasing familiarity with value in medicine, the CW initiative, and cost-related resources. The positive impact of our curricular initiative suggests that there is opportunity the incorporate principles of value-based healthcare into medical education curricula more broadly.

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