Integrating Choosing Wisely, Value-Based Care Principles, Into Undergraduate Medical Education: A Pilot Study

Omar El Fadel; Zachary N Goldberg; Amiti Jain; Nitya Venkat; Anjali Upadhyaya; Shale Mack; Mitchell Kaminski; Dimitri Papanagnou; Deborah Ziring; Geoffrey Hayden

doi:10.7759/cureus.56912

Integrating Choosing Wisely, Value-Based Care Principles, Into Undergraduate Medical Education: A Pilot Study

Cureus. 2024 Mar 25;16(3):e56912. doi: 10.7759/cureus.56912. eCollection 2024 Mar.

Affiliations

¹ Internal Medicine, Thomas Jefferson University, Philadelphia, USA.
² Family and Community Medicine, Thomas Jefferson University, Philadelphia, USA.
³ Emergency Medicine, Thomas Jefferson University, Philadelphia, USA.

Abstract

Background: Healthcare spending represents a large portion of the GDP of the United States. Value-based care (VBC) seeks to decrease waste in health care spending, yet this concept is insufficiently taught to medical students. The Choosing Wisely Students and Trainees Advocating for Resource Stewardship (STARS) campaign promotes initiatives that integrate knowledge of VBC into undergraduate medical education (UME). This study sought to determine the most effective strategy to educate medical students on key principles of VBC as taught by the STARS campaign.

Methods: Choosing Wisely principles were incorporated into the UME curriculum of an academic medical institution via the creation of eight new learning objectives (LOs) for case-based learning (CBL) sessions and lectures. Medical students completed an annual 10-question survey from 2019 to 2022 and 10 formal examination questions during the preclinical (years 1 and 2) curriculum after exposure to varying quantities of LOs. Pearson correlation, chi-square, and logistic regression were employed to determine the association between increased LOs in the curriculum and (1) campaign awareness and (2) knowledge of VBC principles.

Results: A total of 700 survey responses over a four-year period (2019 to 2022) were analyzed. Student awareness of the campaign and knowledge of VBC principles increased year over year during the survey period (39% to 92% and 64% to 74%, respectively). There were significant associations between increased LOs in the curriculum and (1) campaign awareness (0.828, p<0.0001) and (2) knowledge of VBC principles (0.934, p<0.001). Students also performed well on formal examination questions related to VBC principles (mean: 81.5% and mean discrimination index: 0.18).

Conclusion: Integration of VBC-focused LOs is significantly associated with awareness of the Choosing Wisely STARS campaign and knowledge of VBC principles taught by the campaign. Collaborative initiatives to increase exposure to VBC education may improve students' knowledge of these principles during medical school.

Keywords: choosing wisely; health systems science; high-value care; medical education; resource stewardship; value-based care.