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Factors Associated with Medical Students’ Attitudes About Cost-Conscious Care: A Mixed-Methods Multi-school Study

  • Original Research: Qualitative Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

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.

Design

Quantitative and qualitative analysis of a multi-institutional survey.

Participants

Medical students from nine US medical schools.

Approach

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.

Key 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.

Conclusion

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.

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Acknowledgements

The authors wish to thank Serge Mordang (Maastricht University, Netherlands) for permission to use the MHAQ, Andrea Leep Hunderfund (Mayo Clinic, Rochester MN) for advice on survey distribution, and the STARS (Students and Trainees Advocating for Resource Stewardship) Program and STARS Research Consortium for their support of this work.

Funding

The Family Medicine program at OHSU provided $500 in funding.

Author information

Authors and Affiliations

  1. Department of Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA

    Hunter Niehus MD, Ali Noel Gunesch BS, Patricia A. Carney MS, PhD & Andrea Smeraglio MD

  2. Portland Veterans Hospital Administration, Portland, OR, USA

    Hunter Niehus MD & Andrea Smeraglio MD

  3. Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA

    Nina Rodriguez BA & Anne S Linker MD

  4. Dell Medical School at The University of Austin, Austin, TX, USA

    Julianna Khoury MD, MBA

  5. University of Massachusetts Chan Medical School, Worcester, MA, USA

    Annie Ma BS

  6. University of Virginia School of Medicine, Charlottesville, VA, USA

    Nina Gu BS & Glenn Moulder MD

  7. William Carey University College of Osteopathic Medicine, Hattiesburg, MS, USA

    Thy Cao DO & Melissa Stephens MD

  8. University of Chicago Pritzker School of Medicine, Chicago, IL, USA

    Megan Muller BA & Micah Prochaska MD, MSc

  9. Costs of Care, Boston, MA, USA

    Christopher Moriates MD

  10. University of Massachusetts Chan Medical School Bay State, Northampton, MA, USA

    David Fish MD

  11. VA Greater Los Angeles Healthcare System and UCLA, Los Angeles, CA, USA

    Christopher Moriates MD

Authors
  1. Hunter Niehus MD
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  2. Ali Noel Gunesch BS
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  3. Nina Rodriguez BA
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  4. Julianna Khoury MD, MBA
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  5. Annie Ma BS
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  6. Nina Gu BS
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  7. Thy Cao DO
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  8. Megan Muller BA
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  9. Christopher Moriates MD
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  10. Anne S Linker MD
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  11. Micah Prochaska MD, MSc
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  12. David Fish MD
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  13. Glenn Moulder MD
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  14. Melissa Stephens MD
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  15. Patricia A. Carney MS, PhD
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  16. Andrea Smeraglio MD
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Contributions

Criteria for authorship: Hunter Niehus: conceptualization, formal analysis, investigation, methodology, project administration, validation, writing—original draft, writing—review and editing. Ali Gunesch: conceptualization, formal analysis, investigation, methodology, project administration, validation, writing—original draft, writing—review and editing. Nina Rodriguez: investigation, writing—original draft, writing—review and editing. Julianna Khoury: investigation, writing—original draft, writing—review and editing. Annie Ma: investigation, writing—original draft, writing—review and editing. Nina Gu: investigation, writing—original draft, writing—review and editing. Thy Cao: investigation, writing—original draft, writing—review and editing. Megan Muller: investigation, writing—original draft, writing—review and editing. Christopher Moriates: conceptualization, investigation, writing—original draft, writing—review and editing. Anne Linker: investigation, writing—original draft, writing—review and editing. Micah Prochaska: investigation, writing—original draft, writing—review and editing. David Fish: investigation, writing—original draft, writing—review and editing. Glenn Moulder: investigation, writing—original draft, writing—review and editing. Melissa Stephens: investigation, writing—original draft, writing—review and editing. Patricia A. Carney: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, supervision, validation, visualization, writing—original draft, writing—review and editing. Andrea Smeraglio: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, supervision, validation, writing—original draft, writing—review and editing.

Corresponding author

Correspondence to Andrea Smeraglio MD.

Ethics declarations

Conflict of Interest:

Dr. Moriates is the Executive Director for the national non-profit organization Costs of Care and the founder of the STARS program in the United States. Drs. Moriates, Smeraglio, and Prochaska have a grant through The Arnold Foundation to study education around High Value Cost Conscious Care.

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Niehus, H., Gunesch, A.N., Rodriguez, N. et al. Factors Associated with Medical Students’ Attitudes About Cost-Conscious Care: A Mixed-Methods Multi-school Study. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-08783-x

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  • DOI: https://doi.org/10.1007/s11606-024-08783-x

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