Teaching high-value care: a novel morning report.

BACKGROUND

Despite rising health care costs and calls for the incorporation of high-value care (HVC) into medical training, there are few described curricula to address this need.

METHODS

We designed a single-group pre/post comparison to evaluate the impact of a 45-minute HVC morning report in one academic internal medicine programme on the trainees' self-reported knowledge of costs for common diagnostic tests, impact on future ordering practices and the educational value of the intervention. Medical trainees completed a diagnostic evaluation for a hypothetical case within the constraints of a budget during the morning report. Trainees completed a pre/post intervention survey regarding knowledge and attitudes towards HVC, and an evaluation of the intervention. The Wilcoxon signed rank test was used to determine differences between the pre/post intervention survey responses. There are few described curricula to address the need for the incorporation of high-value care into medical training

RESULTS

Fifty-eight trainees participated in the educational activity: 57 completed the survey and 54 completed the evaluation. Our results indicate a significant increase following the morning report intervention in: the trainees' self-reported understanding of the cost for diagnostic tests (p < 0.001); the likelihood the cost of diagnostic tests would affect their future ordering practices (p < 0.001); and the likelihood that the cost of diagnostic tests would affect their timing of a diagnostic evaluation (p ≤ 0.001). The results also indicated a significant decrease in the likelihood that trainees would order extra diagnostic evaluations following the intervention (p = 0.015), and 96 per cent felt that the session was educationally valuable.

DISCUSSION

A morning report incorporating cost of care can significantly increase trainees' perceived understanding of cost and affect self-reported ordering practices in an educationally valuable intervention.