Knight Cancer Institute, Oregon Health & Sciences University, Portland, OR, USA.
Department of Medicine, Division of Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Curr Hematol Malig Rep. 2020 Aug;15(4):248-253. doi: 10.1007/s11899-020-00595-0.
Despite national-level directives to reduce healthcare waste and promote high-value care (HVC), clinical educators struggle to equip trainees with the knowledge and skills needed to practice value-based care. In this review, we analyze ongoing efforts in graduate medical education (GME) to enhance trainee competence in delivery of high-value and cost-conscious care.
Surveys of residents and program directors have shown that while many training programs want to offer formal training in high-value care delivery, few succeed. Although several studies suggest that trainees model stewardship behaviors after clinical preceptors, there remains a shortage of faculty role models skilled in providing HVC. Preparing future hematologist-oncologists to provide cost-conscious care will require significant cultural change at the institutional and program levels and will depend heavily on the development of skilled clinical role models.
尽管国家层面有减少医疗废物和提倡高价值医疗(HVC)的指令,但临床教育工作者仍难以让学员具备实施基于价值的医疗所需的知识和技能。在这篇综述中,我们分析了研究生医学教育(GME)中为提高学员提供高价值和成本意识的医疗服务能力的持续努力。
对住院医师和项目主任的调查显示,尽管许多培训计划希望提供有关提供高价值医疗服务的正式培训,但很少有成功的。尽管有几项研究表明,学员在临床导师的指导下模仿管理行为,但在提供 HVC 方面熟练的师资角色模型仍然短缺。要培养未来的血液科肿瘤学家提供具有成本意识的医疗服务,需要在机构和项目层面上进行重大的文化变革,并且将严重依赖于熟练的临床角色模型的发展。