Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Department of Surgery, University of California Davis, 2335 Stockton Blvd., Sacramento, CA, 95817, USA.
Adv Health Sci Educ Theory Pract. 2019 Oct;24(4):751-766. doi: 10.1007/s10459-019-09896-3. Epub 2019 May 29.
Although incorporating cost-considerations during healthcare decision-making is increasingly important to American patients and physicians, content related to these constructs is not routinely included in medical education. As a result, physicians are ill-equipped to consider costs. This study sought input from practicing physicians on perceived deficiencies in current teaching and recommendations for necessary content to include in medical teaching. We conducted a qualitative descriptive study using semi-structured interviews utilizing a purposeful maximum variation sample of cardiologists and neonatologists practicing in diverse settings. We analyzed interviews using conventional content analysis. 18 cardiologists and 17 neonatologists participated in this study. Respondents perceived that current teaching does not impart sufficient knowledge of value and cost considerations to achieve patient-centered, high-value decision-making. They identified the following priority areas for education related to healthcare costs: the business of medicine and information about out-of-pocket patient costs, training in health research interpretation skills to critically appraise evidence, and communication skills to engage patients as partners in shared decision-making. Participants recommended a variety of teaching methods, including didactic sessions on core topics, role modeling and case studies. American physicians perceive learning needs related to the incorporation of costs into clinical decision-making that can inform curriculum development initiatives in this field. Physicians perceive knowledge of these topics and skills to be crucial to achieving patient-centered high-value care. Concomitant health system reforms supporting the needs of the patient at its center are essential to enable physicians to focus on a patient-centered approach to healthcare delivery.
尽管在美国患者和医生中，在医疗保健决策中考虑成本变得越来越重要，但与这些概念相关的内容通常不包含在医学教育中。因此，医生不具备考虑成本的能力。本研究旨在从执业医生那里获取有关当前教学中存在的不足的意见，并就医学教学中应包含的必要内容提出建议。我们采用目的明确的最大变异样本，对在不同环境中工作的心脏病专家和新生儿科医生进行了半结构化访谈，采用定性描述性研究方法。我们使用常规内容分析对访谈进行了分析。共有 18 名心脏病专家和 17 名新生儿科医生参与了这项研究。受访者认为，目前的教学并没有传授足够的关于价值和成本考虑的知识，以实现以患者为中心的、高价值的决策。他们确定了与医疗保健成本相关的教育的以下优先领域：医学业务和患者自付费用的相关信息、培训健康研究解读技能以批判性评估证据，以及与患者沟通的技能，以使其成为共同决策的合作伙伴。参与者建议采用多种教学方法，包括核心主题的讲座、角色扮演和案例研究。美国医生认为，有必要学习将成本纳入临床决策的相关知识，这可以为该领域的课程开发计划提供信息。医生认为了解这些主题和技能对于实现以患者为中心的高价值护理至关重要。同时，支持以患者为中心的卫生系统改革对于使医生能够专注于以患者为中心的医疗服务提供方式也是必不可少的。
