A survey conducted by the Clerkship Directors in Internal Medicine reveals a disparity between the perceived importance of teaching in high-value care (HVC) and current state of instruction on the topic in internal medicine clerkships. The research findings were presented in  “Current and Optimal Training in High-Value Care in the Internal Medicine Clerkship: A National Curricular Needs Assessment”, published in the March 2018 issue of Academic Medicine, by doctors Danelle Cayea, Kimberly Taraglia, Amit Pahwa, Heather Harrell, Amy Shaheen, and Valerie J. Lang.

The study shows that high-value care (HVC) is insufficiently taught and assessed in medical school due to several factors. As part of CDIM’s 2014 annual survey, 121 U.S. and Canadian medical school clerkship directors were asked a series of questions about the importance of high-value care instruction. The majority of respondents (91.4%) agreed that medical schools have a responsibility to teach about HVC, yet only 32.9% reported that their curricula included formal instruction on this topic. A majority of clerkship directors found the amount of instruction dedicated to HVC was insufficient (70.2%).

Survey results show that lack of dedicated time in the curriculum (73.4%) and lack of faculty time to teach (68.1%) are the top barriers to implementing HVC instruction. Other contributing factors included lack of curricular materials, faculty development, and dedicated curricular time. The study cites that curricular teaching tools, including Aquifer High Value Care, are currently available and would benefit from further dissemination.

Originally developed by expert members of CDIM and adopted from the ACP and AAIM HVC resident curriculum, the Aquifer High Value Care virtual patient cases model best-practices in high-value care. The original content recently expanded to 12 cases, which include the pediatric population and specialties outside of internal medicine. All are available free of change. Dr. Heather Harrell, study co-author and Aquifer High Value Care Senior Director noted. “The Aquifer High Value Care curriculum is uniquely suited to help address this gap and perceived barriers to HVC education in U.S. medical schools. With very little faculty time required, educators can assign the entire course, or just a selection of cases depending on the needs of their program.”

Aquifer Consortium members Dr. Amit Pahwa, Dr. Heather Harrell, and Dr. Valerie Lang participated as co-authors in the study. Dr. Amit Pahwa is an Associate Director of the Aquifer High Value Care Course Board, an Assistant Professor of Medicine, and Director of Hospital Medicine Sub-Internship at Johns Hopkins University School of Medicine. Dr. Heather Harrell is the Senior Director of Aquifer High Value Care Course Board, a Professor of Medicine and Co-Director of Internal Medicine Clerkship at the University of Florida, Gainesville, and former CDIM President (2012-2013). Dr. Valerie Lang is the Aquifer Academic Director for Assessment, an Associate Professor of Medicine at the University of Rochester, and former CDIM President (2014-2015).


Aquifer (formerly MedU) is a thriving, collaborative community of healthcare education leaders deeply committed to driving innovation in teaching and learning. The Aquifer Consortium brings together more than 200 healthcare educators across disciplines to collaborate, innovate, and make advances in health professions education. For educators and healthcare providers, participation in the Consortium offers a unique cross-disciplinary peer community and an exciting opportunity for academic scholarship and advancement.