Aquifer High Value Care, a free course available to all faculty and learners, teaches students how their decisions about diagnostic testing, care management, and other interventions affect the costs and efficacy of care. This 12 case course is an innovative, interdisciplinary approach to teaching the fundamentals of value in healthcare. In our recent 30-minute webinar, Best Practices for Teaching About High Value Care, the Aquifer High Value Care Course Board discussed tips and strategies for teaching about high value care (HVC) throughout the curriculum.
Developing HVC Advocates in Clinical Rotations
At the University of Florida, Heather Harrell, MD, FACP, wanted to empower students to become HVC champions and give them an opportunity to reflect on the real cost of care for patients. Dr. Harrell based her internal medicine clerkship implementation on the work of Dr. Marty Muntz from the Medical College of Wisconsin, who created the role of a “Student High Value Care Champion”, based on the Choosing Wisely campaign for inpatient medicine to focus on areas of waste in medical care. In order for students to truly become advocates, they needed background in high value care, but Dr. Harrell did not have the faculty time to cover this multiple times per year with each clerkship rotation.
To overcome this lack of time, she implemented Aquifer High Value Care cases 1 & 4 as background, introducing students to the HVC curriculum and allowing students to dive deeper into the subject matter. Students were also given the opportunity to, with the patients’ signed consent, view their charges for medical care, and reflect on how choices made by clinicians affected the cost of care. These discussions lead to the incorporation of Aquifer High Value Care cases 6 & 12 to cover payment models, and thus close the loop.
Dr. Harrell noted, “Our experience is that students are so enthusiastic about high value care, and that tying content from the cases to the real patients under their care really brought it to life.” Additionally, by incorporating Aquifer’s HVC cases into their curriculum, Dr. Harrell noted that it helped faculty, many of whom did not have a background in HVC, without creating an additional burden. One of the biggest lessons learned at the University of Florida was that in order for HVC to become the culture, it must be woven throughout the curriculum and patient care.
Individualized Learning During Rotations
Jimmy Beck, MD, MEd, of Seattle Children’s Hospital, uses Aquifer’s High Value Care cases during his pediatrics rotation as a basis for 1-on-1 discussion sessions with medical students. The cases also provide a self-directed learning opportunity, especially during downtime in the hospital. Dr. Beck assigns students specific cases, and upon completion, sits down to discuss them and answer focused questions from the Aquifer High Value Care Educator Guide. These informal discussions are often related to the learning from one of the patients under their care, with the student driving the conversation.
“Students have really appreciated having one-on-one time, but also getting a break from me where they’re not sitting in the cubicle next to me for eight hours during the day,” Dr. Beck mentions. Also, because the Aquifer High Value Care cases are brief, students are able to fit them in during the day at points that are most convenient for them. This learner-centric model is beneficial for both student and faculty, as the faculty are able to better determine where the student is in terms of comprehension and understanding in the moment, so as to be able to tailor the next day’s learning to what the student needs.
Empowering Pre-Clinical Learners as HVC Champions
As a medical student at the University of South Carolina School of Medicine Greenville, Haritha Pavuluri noted that students have a gap in their education because of very little exposure to the concepts of high value care. As part of both the HVC honors track in her program, and the STARS program, she engaged faculty and other students to increase HVC education.
After gaining buy-in from faculty and leadership in her program, Haritha helped design a curricular intervention to introduce high value care to first-year students in their longitudinal “doctoring” course. An introductory lecture helped students learn more about the importance and concepts of high value care, as well as the tenets of the “Choosing Wisely” campaign. Choosing Wisely and HVC concepts were incorporated into the already assigned weekly patient cases and clinical decision-making discussions in the course, thus marrying the concepts of HVC to the material from the start of their medical school experience. Course evaluations showed that students increased their high value care knowledge and confidence in applying HVC and clinical decision-making. More than 95% of students surveyed felt that it was important for students to be educated on HVC.
“I think Aquifer’s High Value Care course has strong utility, in that it provides essential education and ways to apply that knowledge in the clinical environment. Because of this, I think the course is a great resource for faculty and learners alike and forms a great foundation to build further high value care knowledge,” said Haritha. She noted that students became passionate about HVC after being exposed to the ideas and concepts, but making it happen required faculty champions and buy-in from the top down at the school. Students also stressed the importance of faculty needing to engage students in discussions to solidify the concepts of HVC both prior to and during clinical rotations, as well as providing an avenue for discussing instances of low-value care when observed.
High Value Care Shark Tank
First Year Students
At Johns Hopkins University School of Medicine, Dr. Amit Pahwa helps preclinical students get up to speed with a three-day high value care course to introduce students to the concepts before they begin to see patients. In this course, first-year medical students used Aquifer High Value Care cases 1, 6, and 12 to provide foundational knowledge on the tenets of HVC. The material brought up in the cases was then extended through lectures and discussions on topics such as Imaging Wisely, Ordering Wisely, and more. To see how students synthesized all of the information, they were tasked with a Shark Tank project, where they had to find ways to decrease unnecessary tests and treatments for patients. Dr. Pahwa commented “We were able to see that they could put all of the knowledge they got from both the modules and the lectures into their final project.”
Although students did not have much clinical experience when beginning this course, they were able to apply this knowledge when they moved to clinic. “This course provides an opportunity to start the conversation on HVC as early as the first year.” Dr. Pahwa notes. “And this course remains one of the highest-rated in the school.”
Third and Fourth Year Students
Dr. Pahwa also used Aquifer’s High Value Care cases in a unique two-week elective course. Working with Dr. Andrew Parsons from the University of Virginia, Dr. Pahwa implemented a virtual course for third and fourth-year students using a range of resources and culminating with a High Value Care Shark Tank project. To read more about this HVC Shark Tank course and view the complete curriculum for the elective, view Dr. Parsons’ blog “From Health Systems to the Bedside: High-Value Care 101.”