The Association Between Residency Training and Internists’ Ability to Practice Conservatively

Sirovich, Brenda E.; Lipner, Rebecca S.; Johnston, Mary M.; Holmboe, Eric S.

doi:10.1001/jamainternmed.2014.3337

Cited by 124 publications

(97 citation statements)

References 26 publications

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“…29 The training environment has been found to significantly influence physician behavior, specifically with regard to practicing cost-conscious care. 8,30 Therefore, hospitals and teaching institutions should look for opportunities to demonstrate values and beliefs that model cost-conscious care. Such a model would celebrate restraint and promote physicians who act as good stewards of health care resources.…”

Section: Discussionmentioning

confidence: 99%

“…7 Physicians begin to form habits during residency training that may impact their future practice patterns. 8 More experienced faculty physicians at teaching hospitals serve as rolemodels for trainees. [9][10][11] However, many faculty physicians trained in a culture that did not place as much emphasis on reducing unnecessary costs of care; therefore, they must adapt their own teaching methods and practice patterns to better influence trainees to be good stewards of health care resources.…”

Section: Introductionmentioning

confidence: 99%

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Role-Modeling Cost-Conscious Care—A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States

et al. 2015

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BACKGROUND:Little is known about how well faculty at teaching hospitals role-model behaviors consistent with cost-conscious care. OBJECTIVE: We aimed to evaluate whether residents and program directors report that faculty at their program consistently role-model cost-conscious care, and whether the presence of a formal residency curriculum in costconscious care impacted responses. DESIGN: Cost-conscious care surveys were administered to internal medicine residents during the 2012 Internal Medicine In-Training Examination and to program directors during the 2012 Association of Program Directors in Internal Medicine Annual Survey. Respondents stated whether or not they agreed that faculty in their program consistently role-model cost-conscious care. To evaluate a more comprehensive assessment of faculty behaviors, resident responses were matched with those of the director of their residency program. A multivariate logistic regression model was fit to the outcome variable, to identify predictors of responses that faculty do consistently rolemodel cost-conscious care from residency program, resident, and program director characteristics. PARTICIPANTS: Responses from 12,623 residents (58.4 % of total sample) and 253 program directors (68.4 %) from internal medicine residency programs in the United States were included. MAIN MEASURES: The primary outcome measure was responses to questionnaires on faculty role-modeling cost-conscious care. KEY RESULTS: Among all responses in the final sample, 6,816 (54.0 %) residents and 121 (47.8 %) program directors reported that faculty in their program consistently role-model cost-conscious care. Among paired responses of residents and their program director, the proportion that both reported that faculty do consistently rolemodeled cost-conscious care was 23.0 % for programs with a formal residency curriculum in cost-conscious care, 26.3 % for programs working on a curriculum, and 23.7 % for programs without a curriculum. In the adjusted model, the presence of a formal curriculum in costconscious care did not have a significant impact on survey responses (odds ratio [OR] were not consistently role-modeling cost-conscious care. The presence of a formal residency curriculum in costconscious care did not impact responses. Future efforts should focus on placing more emphasis on faculty development and on combining curricular improvements with institutional interventions to adapt the training environment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Role-Modeling Cost-Conscious Care—A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States

et al. 2015

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“…Performance of appropriately conservative care on standardized tests has been shown to mirror the intensity of practice at the training institution [5]. The culture and practice patterns of training environments are powerful forces which shape physicians’ cost consciousness in their subsequent practices [6,7].…”

Section: Discussionmentioning

confidence: 99%

A multimodal high-value curriculum affects drivers of utilization and performance on the high-value care component of the internal medicine in-training exam

Chau

Loertscher

2018

Journal of Community Hospital Internal Medicine Perspectives

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Background: Teaching the practice of high-value care (HVC) is an increasingly important function of graduate medical education but best practices and long-term outcomes remain unknown. Objective: Whether a multimodal curriculum designed to address specific drivers of low-value care would affect resident attitudes, skills, and performance of HVC as tested by the Internal Medicine In-Training Exam (ITE). Methods: In 2012, we performed a baseline needs assessment among internal medicine residents at a community program regarding drivers of healthcare utilization. We then created a multimodal curriculum with online interactive worksheets, lectures, and faculty buy-in to target specific skills, knowledge, and culture deficiencies. Perceived drivers of care and performance on the Internal Medicine ITE were assessed yearly through 2016. Results: Fourteen of 27 (52%) residents completed the initial needs assessment while the curriculum was eventually seen by at least 24 of 27 (89%). The ITE was taken by every resident every year. Long-term, 3-year follow-up demonstrated persistent improvement in many drivers of utilization (patient requests, reliance on subspecialists, defensive medicine, and academic curiosity) and improvement with sustained high performance on the high-value component of the ITE. Conclusion: A multimodal curriculum targeting specific drivers of low-value care can change culture and lead to sustained improvement in the practice of HVC.

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“…1 Physicians' ordering behaviours and resource use are strongly influenced by practices that they were exposed to during training. 2,3 In addition, the Royal College of Physicians and Surgeons of Canada updated its CanMEDS Physician Competency Framework in 2015 and now clearly identifies resource stewardship as a key physician competency within the "Leader" role that must be addressed in residency training. 4 However, given that these changes are relatively recent, many curricula and residency programs at Canadian medical schools do not have consistent content on resource stewardship.…”

mentioning

confidence: 99%

Choosing Wisely Canada Students and Trainees Advocating for Resource Stewardship (STARS) campaign: a descriptive evaluation

et al. 2017

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The Association Between Residency Training and Internists’ Ability to Practice Conservatively

Cited by 124 publications

References 26 publications

Role-Modeling Cost-Conscious Care—A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States

Role-Modeling Cost-Conscious Care—A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States

A multimodal high-value curriculum affects drivers of utilization and performance on the high-value care component of the internal medicine in-training exam

Choosing Wisely Canada Students and Trainees Advocating for Resource Stewardship (STARS) campaign: a descriptive evaluation

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