Medical Student Perceptions of Cost-Conscious Care in an Internal Medicine Clerkship: A Thematic Analysis.
BACKGROUND
Although as much as 87 % of all healthcare spending is directed by physicians, studies have demonstrated that they lack knowledge about the costs of medical care. Similarly, learners have not traditionally received instruction on cost-conscious care.


OBJECTIVE
To examine medical students' perceptions of healthcare delivery as it relates to cost consciousness


METHODS
Retrospective qualitative analysis of medical student narratives


METHODS
Third-year medical students during their inpatient internal medicine clerkship


METHODS
Students completed a reflective exercise wherein they were asked to describe a scenario in which a patient experienced lack of attention to cost-conscious care, and were asked to identify solutions and barriers. We analyzed these reflections to learn more about students' awareness and perceptions regarding the practice of cost-conscious care within our medical center.


RESULTS
Eighty students submitted the assignment between July and December 2012. The most common problems identified included unnecessary tests and treatments (n = 69) and duplicative tests and treatments (n = 20.) With regards to solutions, students described 82 scenarios, with 125 potential solutions identified. Students most commonly used discussion with the team (speak up, ask why) as the process they would use (n = 28) and most often wanted to focus lab testing (n = 38) as the intervention. The most common barriers to high-value care included increased time and effort (n = 19), ingrained practices (n = 17), and defensive medicine or fear of missing something (n = 18.)


CONCLUSIONS
Even with minimal clinical experience, medical students were able to identify instances of lack of attention to cost-conscious care as well as potential solutions. Although students identified the hierarchy in healthcare teams as a potential barrier to improving high value care, most students stated they would feel comfortable engaging the team in discussion. Future efforts to empower learners at all levels to question value decisions and to develop and implement solutions may result in improved healthcare.
Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Kimberly.Tartaglia@osumc.edu.
Kimberly M
KM
Tartaglia
Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Nicholas
N
Kman
Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Cynthia
C
Ledford
D002982:Clinical Clerkship / Q000379:methods / Q000592:standards*; D005260:Female; D017048:Health Care Costs / Q000592:standards*; D006801:Humans; D007388:Internal Medicine / Q000379:methods / Q000592:standards*; D008297:Male; D010465:Perception; D012189:Retrospective Studies; D013337:Students, Medical; D011795:Surveys and Questionnaires
Healthcare costs; Medical education—qualitative analysis; Medical education—systems-based practice