Department of Medicine, Stanford University School of Medicine, Stanford, California.
Center for Health Policy/Primary Care and Outcomes Research, Stanford University, Stanford, California.
Postgrad Med J. 2017 Dec;93(1106):725-729. doi: 10.1136/postgradmedj-2016-134617. Epub 2017 Jun 29.
Most residency programmes do not have a formal high value care curriculum. Our goal was to design and implement a multidisciplinary high value care curriculum specifically targeted at interns.
Our curriculum was designed with multidisciplinary input from attendings, fellows and residents at Stanford. Curricular topics were inspired by the American Board of Internal Medicine's Choosing Wisely campaign, Alliance for Academic Internal Medicine, American College of Physicians and Society of Hospital Medicine. Our topics were as follows: introduction to value-based care; telemetry utilisation; lab ordering; optimal approach to thrombophilia work-ups and fresh frozen plasma use; optimal approach to palliative care referrals; antibiotic stewardship; and optimal approach to imaging for low back pain. Our curriculum was implemented at the Stanford Internal Medicine residency programme over the course of two academic years (2014 and 2015), during which 100 interns participated in our high value care curriculum. After each high value care session, interns were offered the opportunity to complete surveys regarding feedback on the curriculum, self-reported improvements in knowledge, skills and attitudinal module objectives, and quiz-based knowledge assessments.
The overall survey response rate was 67.1%. Overall, the material was rated as highly useful on a 5-point Likert scale (mean 4.4, SD 0.6). On average, interns reported a significant improvement in their self-rated knowledge, skills and attitudes after the six seminars (mean improvement 1.6 points, SD 0.4 (95% CI 1.5 to 1.7), p<0.001).
We successfully implemented a novel high value care curriculum that specifically targets intern physicians.
大多数住院医师培训计划没有正式的高价值医疗课程。我们的目标是设计并实施一项专门针对实习医生的多学科高价值医疗课程。
我们的课程是由斯坦福大学的主治医生、研究员和住院医师共同设计的，借鉴了美国内科医师学院的“明智选择”运动、学术内科医师联盟、美国医师学院和医院医学协会的多学科意见。我们的课程主题如下：基于价值的医疗保健介绍；遥测技术的使用；实验室检测；血栓形成工作流程和新鲜冷冻血浆使用的最佳方法；姑息治疗转诊的最佳方法；抗生素管理；以及用于治疗下腰痛的影像学检查的最佳方法。我们的课程在斯坦福内科住院医师培训计划中实施了两个学年（2014 年和 2015 年），期间有 100 名实习医生参加了我们的高价值医疗课程。每次高价值医疗课程结束后，实习医生都有机会完成关于课程反馈、自我报告的知识、技能和态度模块目标的改进，以及基于测验的知识评估的调查。
总体调查回复率为 67.1%。总体而言，该课程在 5 分制的李克特量表中被评为非常有用（平均 4.4，标准差 0.6）。平均而言，实习医生报告说，在参加完六次研讨会后，他们的自我评估知识、技能和态度有了显著提高（平均提高 1.6 分，标准差 0.4（95%置信区间 1.5 至 1.7），p<0.001）。
我们成功实施了一项针对实习医生的新颖的高价值医疗课程。
