Iscoe Mark, Lord Robert, Schulz John, Lee David, Cayea Danelle, Pahwa Amit
Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Clin Teach. 2018 Feb;15(1):24-28. doi: 10.1111/tct.12613. Epub 2017 Mar 21.
Rising and burdensome health care costs have driven interest in the practice of high-value care (HVC) and have inspired calls for increased HVC training across all levels of medical education, including among undergraduate medical students.
Classroom-based HVC curricula targeted to medical students have not been previously described in the medical literature.
We developed and evaluated a workshop comprising a lecture, a small-group exercise and a group discussion to instruct medical students on interpreting cost-effectiveness analyses (CEA), applying CEA to patient care and discussing the cost of care with patients. From January 2014 to September 2015 the workshop was administered to five cohorts, 120 students in total, in the internal medicine clerkships at two US medical schools. Pre- and post-intervention confidence in various domains was assessed with a Likert-type scale ranging from 1 to 4. The overall response rate was 87.9 per cent. The proportion of students reporting high confidence scores (3 or 4) rose significantly (p < 0.01) in each domain: from 16.2 to 76.9 per cent for calculating an incremental cost-effectiveness ratio (ICER); from 16.0 to 79.6 per cent for interpreting quality-adjusted life-years (QALYs); from 8.7 to 71.3 per cent for using CEA in patient management; and from 15.3 to 71.4 per cent for discussing costs with patients. Students rated the overall quality of the course as 3.82 out of 5. Rising and burdensome health care costs have driven interest in the practice of high-value care IMPLICATIONS: Our experience of developing, evaluating and refining an HVC course targeted at medical students taught us that such a course is needed, can be educational and can be well-received. Future research is needed to assess the effects of curricula on clinical practice.
不断上涨且负担沉重的医疗保健成本引发了人们对高价值医疗（HVC）实践的兴趣，并促使人们呼吁在各级医学教育中增加HVC培训，包括本科医学生。
此前医学文献中尚未描述针对医学生的基于课堂的HVC课程。
我们开发并评估了一个工作坊，该工作坊包括一次讲座、一次小组练习和一次小组讨论，旨在指导医学生解读成本效益分析（CEA）、将CEA应用于患者护理以及与患者讨论护理成本。2014年1月至2015年9月，该工作坊在美国两所医学院的内科实习中对五个班级的学生进行了授课，共计120名学生。干预前后，使用1至4分的李克特量表评估学生在各个领域的信心。总体回复率为87.9%。在每个领域，报告高信心得分（3分或4分）的学生比例均显著上升（p < 0.01）：计算增量成本效益比（ICER）的比例从16.2%升至76.9%；解读质量调整生命年（QALY）的比例从16.0%升至79.6%；在患者管理中使用CEA的比例从8.7%升至71.3%；与患者讨论成本的比例从15.3%升至71.4%。学生对课程总体质量的评分是5分中的3.82分。不断上涨且负担沉重的医疗保健成本引发了人们对高价值医疗实践的兴趣。
我们开发、评估和完善针对医学生的HVC课程的经验告诉我们，这样的课程是必要的，具有教育意义且能受到好评。未来需要开展研究以评估课程对临床实践的影响。
