HSC Education Days
Choosing Wisely at UNM School of Medicine
This presentation was presented during the University of New Mexico Health Sciences Center Education Day, 2019.
Abstract
The cost of healthcare in the United States is rising and consumes around 20% of our GDP. High costs of care negatively impact patients as well as our healthcare system. High-value care is a movement aimed at balancing clinical benefit with cost, with the goal of improving patient outcomes. Prior to this, there have been no organized efforts to introduce pre-clinical medical students to issues of cost and value at UNM SOM. Last year at UNM, two first-year medical students were accepted into the national Choosing Wisely STARS (Students and Trainees Advocating for Resource Stewardship) program and received faculty mentorship as well as training at a national leadership summit to implement change at the local level. The students conducted a survey of their classmates at the end of the Practical Immersion Experience (PIE) to assess student exposure to the concept of high value care. While the survey results indicated that most students understand the basic definition of high value care, it also shows that over 80% of students encountered patients for whom the cost of care was a problem at least weekly, and that further opportunities exist within the curriculum to better prepare students. Over 80% of students felt unprepared to discuss issues of costs of care with patients, over 60% of students did not feel that doctors talked enough to patients about costs of care, and over 60% did not feel that the school of medicine adequately prepares students to understand the cost burden on patients. Students were offered a badge card prior to PIE that highlighted the principles of high value care, but less than 10% of students used the card or the highlighted resources. Further work is needed to support students in learning about the issues of cost and value and how these issues affect our patients, and we are working to implement changes in the curriculum within PIE, Clinical Reasoning, and the continuity clinic portion of Doctoring to help introduce students to this issue.
