Steele Christopher, Cayea Danelle, Berk Justin, Riddell Rebecca, Kumra Tina, McGuire Maura, Pahwa Amit K
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Division of General Internal Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA.
Clin Teach. 2019 Oct;16(5):513-518. doi: 10.1111/tct.12989. Epub 2019 Jan 15.
Most medical schools teach a high-value care (HVC) curriculum during the clinical years. Currently, there lacks any research demonstrating the effectiveness of the HVC curriculum taught to students in their first year of medical school.
A total of 118 of 466 first-year medical students at Johns Hopkins School of Medicine between 2013 and 2017 enrolled on an HVC course that provided the initial framework necessary to practice cost-conscious clinical medicine. The curriculum was evaluated by comparing the performance of students who completed the course with the performance of students without training, through a standardised patient encounter on musculoskeletal back pain and how to approach a patient's request for imaging. Chi-square testing was used to assess the impact of the course on performance in a standardised patient encounter.
Students enrolled on the HVC course were more likely, compared with their counterparts, to assure patients that back pain was a simple strain (48 versus 31%), and were less likely to ask for preceptor help on how to proceed with management (11 versus 29%) [χ (4, n = 466) = 14.28, p = 0.007]. There were no differences between students enrolled on the HVC course who had not yet received training compared with students taking another elective [χ (4, n = 385) = 8.73, p = 0.07].
This is the first study to assess the effectiveness of an HVC curriculum for first-year medical students, and it demonstrates promise that they can acquire some skill sets necessary for cost-effective practice in a simulated clinical setting. This is the first study to assess the effectiveness of an HVC curriculum for first-year medical students, and it demonstrates promise that they can acquire some skill sets necessary for cost-effective practice.
大多数医学院校在临床阶段教授高价值医疗（HVC）课程。目前，尚无研究证明在医学院校一年级向学生教授HVC课程的有效性。
2013年至2017年间，约翰·霍普金斯医学院466名一年级医学生中有118名参加了一门HVC课程，该课程提供了践行注重成本的临床医学所需的初始框架。通过对肌肉骨骼背痛以及如何处理患者影像学检查请求的标准化患者问诊，比较完成该课程的学生与未接受培训的学生的表现，以此对课程进行评估。采用卡方检验评估该课程对标准化患者问诊表现的影响。
与未参加HVC课程的学生相比，参加该课程的学生更有可能向患者保证背痛只是简单的拉伤（48%对31%），且在如何进行治疗方面向带教老师求助的可能性更小（11%对29%）[χ²(4, n = 466) = 14.28，p = 0.007]。尚未接受培训的参加HVC课程的学生与参加另一门选修课的学生之间没有差异[χ²(4, n = 385) = 8.73，p = 0.07]。
这是第一项评估针对一年级医学生的HVC课程有效性的研究，表明他们有望在模拟临床环境中获得一些具有成本效益的实践所需的技能。这是第一项评估针对一年级医学生的HVC课程有效性的研究，表明他们有望获得一些具有成本效益的实践所需的技能。
