Factors Associated with Medical Students' Attitudes About Cost-Conscious Care: A Mixed-Methods Multi-school Study

Hunter Niehus; Ali Noel Gunesch; Nina Rodriguez; Julianna Khoury; Annie Ma; Nina Gu; Thy Cao; Megan Muller; Christopher Moriates; Anne S Linker; Micah Prochaska; David Fish; Glenn Moulder; Melissa Stephens; Patricia A Carney; Andrea Smeraglio

doi:10.1007/s11606-024-08783-x

Factors Associated with Medical Students' Attitudes About Cost-Conscious Care: A Mixed-Methods Multi-school Study

J Gen Intern Med. 2024 May 6. doi: 10.1007/s11606-024-08783-x. Online ahead of print.

Authors

Hunter Niehus^{1

2}, Ali Noel Gunesch¹, Nina Rodriguez³, Julianna Khoury⁴, Annie Ma⁵, Nina Gu⁶, Thy Cao⁷, Megan Muller⁸, Christopher Moriates^{9

10}, Anne S Linker³, Micah Prochaska⁸, David Fish¹¹, Glenn Moulder⁶, Melissa Stephens⁷, Patricia A Carney¹, Andrea Smeraglio^{12

13}

Affiliations

¹ Department of Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA.
² Portland Veterans Hospital Administration, Portland, OR, USA.
³ Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA.
⁴ Dell Medical School at The University of Austin, Austin, TX, USA.
⁵ University of Massachusetts Chan Medical School, Worcester, MA, USA.
⁶ University of Virginia School of Medicine, Charlottesville, VA, USA.
⁷ William Carey University College of Osteopathic Medicine, Hattiesburg, MS, USA.
⁸ University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
⁹ Costs of Care, Boston, MA, USA.
¹⁰ VA Greater Los Angeles Healthcare System and UCLA, Los Angeles, CA, USA.
¹¹ University of Massachusetts Chan Medical School Bay State, Northampton, MA, USA.
¹² Department of Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA. Smeragli@ohsu.edu.
¹³ Portland Veterans Hospital Administration, Portland, OR, USA. Smeragli@ohsu.edu.

PMID: 38710863
DOI: 10.1007/s11606-024-08783-x

Abstract

Background: Because physician practices contribute to national healthcare expenditures, initiatives aimed at educating physicians about high-value cost-conscious care (HVCCC) are important. Prior studies suggest that the training environment influences physician attitudes and behaviors towards HVCCC.

Objective: To explore the relationship between medical student experiences and HVCCC attitudes.

Design: Quantitative and qualitative analysis of a multi-institutional survey.

Participants: Medical students from nine US medical schools.

Approach: A 44-item survey that included the Maastricht HVCCC Attitudes Questionnaire, a validated tool for assessing HVCCC attitudes, was administered electronically. Attitudinal domains of high-value care (HVC), cost incorporation (CI), and perceived drawbacks (PD) were compared using one-way ANOVA among students with a range of exposures. Open text responses inviting participants to reflect on their attitudes were analyzed using classical content analysis.

Key results: A total of 740 students completed the survey (response rate 15%). Students pursuing a "continuity-oriented" specialty held more favorable attitudes towards HVCCC than those pursuing "technique-oriented" specialties (HVC sub-score = 3.20 vs. 3.06; p = 0.005, CI sub-score = 2.83 vs. 2.74; p < 0.001). Qualitative analyses revealed personal, educational, and professional experiences shape students' HVCCC attitudes, with similar experiences interpreted differently leading to both more and less favorable attitudes.

Conclusion: Students pursuing specialties with longitudinal patient contact may be more enthusiastic about practicing high-value care. Life experiences before and during medical school shape these attitudes, and complex interactions between these forces drive student perceptions of HVCCC.

Keywords: HVC; high-value care; high-value cost-conscious care; undergraduate medical education..