Emergency Medicine Resident Needs Assessment and Preferences for a High-value Care Curriculum.

Abstract

Consideration of the cost of care and value in healthcare is now a recognized element of physician training. Despite the urgency to educate trainees in high-value care (HVC), educational curricula and evaluation of these training paths remain limited, especially with respect to emergency medicine (EM) residents. We aimed to complete a needs assessment and evaluate curricular preferences for instruction on HVC among EM residents. This was a qualitative, exploratory study using content analysis of two focus groups including a total of eight EM residents from a single Midwestern EM residency training program. Participants also completed a survey questionnaire. There were two themes. Within the overall theme of resident experience with and perception of HVC, we found five sub-themes: 1)understanding of HVC focuses on diagnosis and decision-making; 2)concern about patient costs, including the effects on patients' lives and their ability to engage with recommended outpatient care; 3)conflict between internal beliefs and external expectations, including patients' perceptions of value; 4)approach to HVC changes with increasing clinical experience; and 5)slow-moving, political discussion around HVC. Within the overall theme of desired education and curricular design, we identified four sub-themes: 1)limited prior education on HVC and health economics; 2)motivation to receive training on HVC and health economics; 3)desire for discussion-based format for HVC curriculum; and 4)curriculum targeted to level of training. Respondents indicated greatest acceptability of interactive, discussion-based formats. We conducted a targeted needs assessment for HVC among EM residents. We identified broad interest in the topic and limited self-reported baseline knowledge. Curricular content may benefit from incorporating resident concerns about patient costs and conflict between external expectations and internal beliefs about HVC. Curricular design may benefit from a focus on interactive, discussion-based modalities and tailoring to the learner's level of training.