Abstract：
BACKGROUND: Because physician practices contribute to national healthcare expenditures, initiatives aimed at educating physicians about high-value cost-conscious care (HVCCC) are important. Prior studies suggest that the training environment influences physician attitudes and behaviors towards HVCCC.
OBJECTIVE: To explore the relationship between medical student experiences and HVCCC attitudes.
METHODS: Quantitative and qualitative analysis of a multi-institutional survey.
METHODS: Medical students from nine US medical schools.
METHODS: A 44-item survey that included the Maastricht HVCCC Attitudes Questionnaire, a validated tool for assessing HVCCC attitudes, was administered electronically. Attitudinal domains of high-value care (HVC), cost incorporation (CI), and perceived drawbacks (PD) were compared using one-way ANOVA among students with a range of exposures. Open text responses inviting participants to reflect on their attitudes were analyzed using classical content analysis.
RESULTS: A total of 740 students completed the survey (response rate 15%). Students pursuing a \"continuity-oriented\" specialty held more favorable attitudes towards HVCCC than those pursuing \"technique-oriented\" specialties (HVC sub-score = 3.20 vs. 3.06; p = 0.005, CI sub-score = 2.83 vs. 2.74; p < 0.001). Qualitative analyses revealed personal, educational, and professional experiences shape students\' HVCCC attitudes, with similar experiences interpreted differently leading to both more and less favorable attitudes.
CONCLUSIONS: Students pursuing specialties with longitudinal patient contact may be more enthusiastic about practicing high-value care. Life experiences before and during medical school shape these attitudes, and complex interactions between these forces drive student perceptions of HVCCC.
OBJECTIVE: To explore the relationship between medical student experiences and HVCCC attitudes.
METHODS: Quantitative and qualitative analysis of a multi-institutional survey.
METHODS: Medical students from nine US medical schools.
METHODS: A 44-item survey that included the Maastricht HVCCC Attitudes Questionnaire, a validated tool for assessing HVCCC attitudes, was administered electronically. Attitudinal domains of high-value care (HVC), cost incorporation (CI), and perceived drawbacks (PD) were compared using one-way ANOVA among students with a range of exposures. Open text responses inviting participants to reflect on their attitudes were analyzed using classical content analysis.
RESULTS: A total of 740 students completed the survey (response rate 15%). Students pursuing a \"continuity-oriented\" specialty held more favorable attitudes towards HVCCC than those pursuing \"technique-oriented\" specialties (HVC sub-score = 3.20 vs. 3.06; p = 0.005, CI sub-score = 2.83 vs. 2.74; p < 0.001). Qualitative analyses revealed personal, educational, and professional experiences shape students\' HVCCC attitudes, with similar experiences interpreted differently leading to both more and less favorable attitudes.
CONCLUSIONS: Students pursuing specialties with longitudinal patient contact may be more enthusiastic about practicing high-value care. Life experiences before and during medical school shape these attitudes, and complex interactions between these forces drive student perceptions of HVCCC.
摘要：
背景：因为医生实践有助于国家医疗保健支出，旨在对医生进行高价值成本意识护理(HVCCC)教育的举措非常重要.先前的研究表明，培训环境会影响医生对HVCCC的态度和行为。
目的：探讨医学生经历与HVCCC态度之间的关系。
方法：多机构调查的定量和定性分析。
方法：来自美国9所医学院的医学生。
方法：一项44项调查，其中包括马斯特里赫特HVCCC态度问卷，用于评估HVCCC态度的经过验证的工具，以电子方式管理。高价值护理(HVC)的态度领域，成本合并(CI)，和感知缺点（PD）使用单向ANOVA在一系列暴露的学生中进行比较。使用经典内容分析分析了邀请参与者反思其态度的开放式文本响应。
结果：共有740名学生完成了调查（回复率为15％）。追求“连续性导向”专业的学生对HVCCC的态度比追求“技术导向”专业的学生更有利（HVC子分数=3.20vs.3.06；p=0.005，CI子得分=2.83vs.2.74；p<0.001）。定性分析揭示了个人，教育,和专业经验塑造了学生的HVCCC态度，与类似的经验解释不同，导致更多和更少的有利态度。
结论：追求与患者纵向接触的专业的学生可能更热衷于实践高价值护理。医学院之前和期间的生活经历塑造了这些态度，这些力量之间复杂的相互作用驱动了学生对HVCCC的看法。
目的：探讨医学生经历与HVCCC态度之间的关系。
方法：多机构调查的定量和定性分析。
方法：来自美国9所医学院的医学生。
方法：一项44项调查，其中包括马斯特里赫特HVCCC态度问卷，用于评估HVCCC态度的经过验证的工具，以电子方式管理。高价值护理(HVC)的态度领域，成本合并(CI)，和感知缺点（PD）使用单向ANOVA在一系列暴露的学生中进行比较。使用经典内容分析分析了邀请参与者反思其态度的开放式文本响应。
结果：共有740名学生完成了调查（回复率为15％）。追求“连续性导向”专业的学生对HVCCC的态度比追求“技术导向”专业的学生更有利（HVC子分数=3.20vs.3.06；p=0.005，CI子得分=2.83vs.2.74；p<0.001）。定性分析揭示了个人，教育,和专业经验塑造了学生的HVCCC态度，与类似的经验解释不同，导致更多和更少的有利态度。
结论：追求与患者纵向接触的专业的学生可能更热衷于实践高价值护理。医学院之前和期间的生活经历塑造了这些态度，这些力量之间复杂的相互作用驱动了学生对HVCCC的看法。
