Capsule Commentary on Tartaglia et al., Medical Student Perceptions of Cost-Conscious Care in an Internal Medicine Clerkship: A Thematic Analysis

Abstract

T his analysis by Tartaglia et al.[ 1 ] qualitatively examined medical student reflections on cost-conscious care as part of an integrated high-value care curriculum during the thirdyear internal medicine clerkship at the Ohio State University College of Medicine. The curriculum consisted of an online high-value care educational module and a reflective exercise in which students were asked to describe a case from their clerkship that lacked Battention to high-value care,^identify a solution, and discuss potential barriers to the success of the solution. Following student completion of the exercise at a 72 % participation rate, responses were coded and analyzed for themes. The most commonly identified contributors to low-value care included unnecessary or duplicative tests and treatments. Proposed solutions focused on processes such as discussion with the team and on interventions such as more appropriate lab testing. Barriers included time/effort, ingrained practices, and defensive medicine. The majority of respondents reported that an attending physician addressed cost versus benefit with the team.Despite the fact that this was a small, single-institution sample of medical students near the beginning of their clinical training, students were able to identify many common practices, echoed by residents [ 2 ] and attendings [ 3 ], that were not consistent with the practice of high-value care. However, the possibility for availability bias is pronounced, as the themes outlined by students closely mirrored those taught in the required online module. What is most notable is that this is the first assessment of medical student perceptions of costconscious care in the literature. At the very least, this study lends support to the inclusion of medical students in the growing effort to educate learners at all levels on the importance of high-value care. Studies that examine retention or degradation of the knowledge, as well as whether high-value care curricula for medical students can influence behavior of both the students and the teams with which they rotate, would advance this field of inquiry.