PDF(Pubmed)
Abstract：
BACKGROUND: Healthcare spending represents a large portion of the GDP of the United States. Value-based care (VBC) seeks to decrease waste in health care spending, yet this concept is insufficiently taught to medical students. The Choosing Wisely Students and Trainees Advocating for Resource Stewardship (STARS) campaign promotes initiatives that integrate knowledge of VBC into undergraduate medical education (UME). This study sought to determine the most effective strategy to educate medical students on key principles of VBC as taught by the STARS campaign.
METHODS: Choosing Wisely principles were incorporated into the UME curriculum of an academic medical institution via the creation of eight new learning objectives (LOs) for case-based learning (CBL) sessions and lectures. Medical students completed an annual 10-question survey from 2019 to 2022 and 10 formal examination questions during the preclinical (years 1 and 2) curriculum after exposure to varying quantities of LOs. Pearson correlation, chi-square, and logistic regression were employed to determine the association between increased LOs in the curriculum and (1) campaign awareness and (2) knowledge of VBC principles.
RESULTS: A total of 700 survey responses over a four-year period (2019 to 2022) were analyzed. Student awareness of the campaign and knowledge of VBC principles increased year over year during the survey period (39% to 92% and 64% to 74%, respectively). There were significant associations between increased LOs in the curriculum and (1) campaign awareness (0.828, p<0.0001) and (2) knowledge of VBC principles (0.934, p<0.001). Students also performed well on formal examination questions related to VBC principles (mean: 81.5% and mean discrimination index: 0.18).
CONCLUSIONS: Integration of VBC-focused LOs is significantly associated with awareness of the Choosing Wisely STARS campaign and knowledge of VBC principles taught by the campaign. Collaborative initiatives to increase exposure to VBC education may improve students\' knowledge of these principles during medical school.
METHODS: Choosing Wisely principles were incorporated into the UME curriculum of an academic medical institution via the creation of eight new learning objectives (LOs) for case-based learning (CBL) sessions and lectures. Medical students completed an annual 10-question survey from 2019 to 2022 and 10 formal examination questions during the preclinical (years 1 and 2) curriculum after exposure to varying quantities of LOs. Pearson correlation, chi-square, and logistic regression were employed to determine the association between increased LOs in the curriculum and (1) campaign awareness and (2) knowledge of VBC principles.
RESULTS: A total of 700 survey responses over a four-year period (2019 to 2022) were analyzed. Student awareness of the campaign and knowledge of VBC principles increased year over year during the survey period (39% to 92% and 64% to 74%, respectively). There were significant associations between increased LOs in the curriculum and (1) campaign awareness (0.828, p<0.0001) and (2) knowledge of VBC principles (0.934, p<0.001). Students also performed well on formal examination questions related to VBC principles (mean: 81.5% and mean discrimination index: 0.18).
CONCLUSIONS: Integration of VBC-focused LOs is significantly associated with awareness of the Choosing Wisely STARS campaign and knowledge of VBC principles taught by the campaign. Collaborative initiatives to increase exposure to VBC education may improve students\' knowledge of these principles during medical school.
摘要：
背景：医疗保健支出占美国GDP的很大一部分。基于价值的护理(VBC)旨在减少医疗保健支出的浪费，然而，这个概念没有充分教导医学生。明智地选择学生和受训人员倡导资源管理（STARS）活动促进将VBC知识融入本科医学教育（UME）的举措。这项研究旨在确定最有效的策略，以教育医学生有关STARS运动所教授的VBC关键原则。
方法：通过为基于案例的学习（CBL）课程和讲座创建八个新的学习目标（LOs），将明智的原则选择纳入学术医疗机构的UME课程。医学生从2019年到2022年完成了年度10个问题的调查，并在暴露于不同数量的LOs后的临床前（1年和2年）课程中完成了10个正式考试问题。皮尔逊相关性，卡方,和逻辑回归用于确定课程中LOs增加与（1）运动意识和（2）VBC原理知识之间的关联。
结果：分析了四年期间（2019年至2022年）共700份调查回复。在调查期间，学生对运动的认识和对VBC原理的了解逐年增加（39％至92％和64％至74％，分别)。课程中LOs的增加与（1）运动意识（0.828，p<0.0001）和（2）VBC原理知识（0.934，p<0.001）之间存在显着关联。学生在与VBC原则相关的正式考试问题上也表现良好（平均值：81.5％，平均歧视指数：0.18）。
结论：以VBC为重点的LOs的整合与对“明智选择明星”运动的认识以及该运动所教授的VBC原理的知识显着相关。在医学院期间，增加对VBC教育的接触的合作举措可能会提高学生对这些原则的认识。
方法：通过为基于案例的学习（CBL）课程和讲座创建八个新的学习目标（LOs），将明智的原则选择纳入学术医疗机构的UME课程。医学生从2019年到2022年完成了年度10个问题的调查，并在暴露于不同数量的LOs后的临床前（1年和2年）课程中完成了10个正式考试问题。皮尔逊相关性，卡方,和逻辑回归用于确定课程中LOs增加与（1）运动意识和（2）VBC原理知识之间的关联。
结果：分析了四年期间（2019年至2022年）共700份调查回复。在调查期间，学生对运动的认识和对VBC原理的了解逐年增加（39％至92％和64％至74％，分别)。课程中LOs的增加与（1）运动意识（0.828，p<0.0001）和（2）VBC原理知识（0.934，p<0.001）之间存在显着关联。学生在与VBC原则相关的正式考试问题上也表现良好（平均值：81.5％，平均歧视指数：0.18）。
结论：以VBC为重点的LOs的整合与对“明智选择明星”运动的认识以及该运动所教授的VBC原理的知识显着相关。在医学院期间，增加对VBC教育的接触的合作举措可能会提高学生对这些原则的认识。
