%0 Journal Article
%T Factors Associated with Medical Students' Attitudes About Cost-Conscious Care: A Mixed-Methods Multi-school Study.
%A Niehus H
%A Gunesch AN
%A Rodriguez N
%A Khoury J
%A Ma A
%A Gu N
%A Cao T
%A Muller M
%A Moriates C
%A Linker AS
%A Prochaska M
%A Fish D
%A Moulder G
%A Stephens M
%A Carney PA
%A Smeraglio A
%J J Gen Intern Med
%V 0
%N 0
%D 2024 May 6
%M 38710863
%F 6.473
%R 10.1007/s11606-024-08783-x
%X <B>BACKGROUND: </B>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.<BR><B>OBJECTIVE: </B>To explore the relationship between medical student experiences and HVCCC attitudes.<BR><B>METHODS: </B>Quantitative and qualitative analysis of a multi-institutional survey.<BR><B>METHODS: </B>Medical students from nine US medical schools.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.