Assessing resident or student understanding of high value care principles.
Various standardized patient cases with a focus on HVC communication, standardized system cases (OSSIES), and an online virtual patient module that teaches good clinical practice and costs.
Learner Level: Residents (applicable to medical students as well)Program/School: State University of New York Upstate Medical University College of MedicineSubmitted by: Stephen Knohl, MDContext: OutpatientDescription: Standardized patient case with focus on HVC communication skills intended for self-assessment/ formative assessment. Residents interview SP and review the video of themselves to discuss HVC and communication skills. Includes script, checklist for SP to fill out, checklist for resident viewing own video, test/procedure requisition forms with and without cost.
Program/School: Southern Illinois University College of MedicineSubmitted by: Susan Hingle, MDContext: OutpatientDescription: Previously published on MedEdPORTAL. Three standardized patient cases with checklist (on practicing cost-effective patient care, cost-effective disease prevention and health promotion, and cost of medication); and 13 standardized "system" cases (OSSIEs) designed to help programs assess systems-based practice; includes scenarios, target objectives, and assessment tool.Co-authors: Richard Rosher, MD, Sherry Robinson PhD
View Practicing Cost-Effective Patient Care Case
View Cost-Effective Disease Prevention & Health Promotion Case
View Cost of Medication Case
View 13 Standardized "System" Cases
Learner Level: Medical studentsProgram/School: Johns Hopkins School of MedicineSubmitted by: Amit Pahwa, MDContext: OutpatientDescription: This online module is a novel way to assess by giving real time feedback about ordering "efficiency" that teaches both appropriate care and the costs of healthcare. Students are given three patients and asked to enter orders with the Medicare Allowable Fee or Average Wholesale Price. This is to simulate Maryland's new global budget revenue with capitated payment system that reimburses a fix fee per patient.
For access to the site, contact Amit Pahwa, MD directly.
Learner Level: Medical Student (year 3 or 4)Program/School: Ohio State University College of MedicineSubmitted by: Kimberly Tartaglia, MDContext: Not specified (could be inpt, ED or outpt)Description: Standardized patient case with checklist to assess communication with patient about unnecessary imaging for straightforward syncope.
For access to the case, contact Kimberly Tartaglia, MD directly.
Learner Level: Medical students, residents, fellowsProgram/School: University of Minnesota Medical SchoolSubmitted by: Jill Bowman Peterson, MD and Alisa Duran, MDDescription: Three standardized patient encounters with facilitator guides for use in high value care scenarios. These can be used for training to evaluate learner's ability in high value communication skills.Co-authors: Crystal Donelan, Sophia P. Gladding, PhD, Peter Weissman MD, and Craig Roth MD
Exercises to help learners recognize medical overuse and reflect more deeply on their own clinical practice and experiences with patients.
Learner Level: Medical Student, ResidentProgram/School: Ohio State University College of MedicineSubmitted by: Kimberly Tartaglia, MDContext: Not specified. (could be inpatient, ED, or outpatient)Description: After a module on HVC, learner reflects on own experience with a patient. Narrative and reflective exercise focusing on cost conscious care developed for students but easily adapted for residents.
View Reflection Exercise
Learner Level: Medical Students, Residents Program/School: University of Colorado School of Medicine and the Lown InstituteSubmitted by: Brandon Combs, MDDescription: The Do No Harm Project uses narrative medicine to help residents recognize medical overuse and reflect more deeply on their own clinical practice. Provides a general framework for structuring the narrative and a method for implementation into the residency training program. Easily implemented for medical students as well.
View Do No Harm Project
Decision support checklist of tests and procedures from Choosing Wisely and a value based care communication checklist developed using the Four Habits Model of communication.
Learner Level: Clerkship Medical Student (but adaptable for GME level trainees)Program/School: Medical College of WisconsinSubmitted by: Martin Muntz, MDContext: InpatientDescription: Decision support checklist utilizing the five areas of waste (plus two additional) identified by the Society of Hospital Medicine for the Choosing Wisely Campaign. Checklist is utilized on an Ipad and used to guide testing and treatment decisions. This tool may be used as a guide for HVC feedback within the team structure.
Learner Level: Residents, Students, FellowsProgram/School: University of Minnesota Medical SchoolSubmitted by: Alisa Duran, MDContext: Inpatient Description: Value based care communication checklist developed using the Four Habits Model of communication. The tool was utilized in a standardized patient encounter but could be adapted for use in outpatient clinic settings with any learner. This model provides a framework for a patient-centered encounter and allows providers to explore patients' feelings and beliefs behind their desire for diagnostic testing and negotiate a mutually agreeable solution.Co-authors: Craig Roth, MD, Jill Bowman Peterson, MD, Peter Weissmann, MD, Sophia Gladding, PhD, and Crystal Donelan.
Facilitated small group cases focusing on HVC in preventive/screening and an educational conference to explore and identify drivers of medical overuse and associated harms.
Learner Level: Residents (could be used for medical students)Program/School: University of Tennessee Medical Center at KnoxvilleSubmitted by: Mark Rasnake, MDContext: OutpatientDescription: Facilitated discussion/structured small group cases focusing on high value care in preventive care and screening in (Case 1) older female and (Case 2) younger, newly diagnosed Type II diabetic.
View Case 1
View Case 2
Learner Level: Administration, Practicing Physicians, Medical Students, Residents, FellowsProgram/School: University of Colorado School of Medicine and the Lown InstituteSubmitted by: Brandon Combs, MDDescription: “Right Care Rounds” uses the familiar case presentation format to explore and identify drivers of medical overuse and the associated harms in an individual patient case. Right Care Rounds is meant to be easily adaptable and can occur within existing educational time slots e.g. morning report, noon conference, or Grand Rounds and uses the familiar cause‐and‐effect diagram, or “fishbone” as a cognitive tool. Provides a general framework for structuring the narrative and a method for implementation into the residency training program.
View "Right Care Rounds"
Chart stimulated recall with focus on diagnostic testing and management decisions and tool for auditing own or another person's chart for providing preventive care.
Learner Level: ResidentsProgram/School: University of Nebraska College of MedicineSubmitted by: Sarah Richards, MDContext: InpatientDescription: Chart stimulated recall with focus on diagnostic testing and management decisions. Learners review costs of tests and treatments for one inpatient and discuss with the hospitalist. Identify social determinants that may have impacted choices, readmissions, and LOS, identify opportunities for HVC, and generate ideas for a QI project.Co-author: Kelly J. Caverzagie, MD
Learner Level: Residents (IM, Med-Peds, or FM)Program/School: Baylor College of MedicineSubmitted by: Frene' LaCour-Chestnut, MDContext: OutpatientDescription: Pre-visit planning chart tool for auditing own chart or another person’s chart with focus on high value care for providing preventive care. Use limited to the outpatient setting but can be used with residents or students.
15 key features examination and clinical decision-making questions on HVC and an assessment tool for attitudes surrounding HVC practice.
Learner Level: Medical Student (clerkship, subinternship students)Program/School: University of Rochester School of Medicine and DentistrySubmitted by: Valerie J. Lang, MDContext: Inpatient, outpatient or EDDescription: Assessment tool for attitudes surrounding the practice of high value care utilized for medical students at different levels of training. Easily adaptable for learners at different levels. Tool could be additionally utilized in high value care discussions. Narrative and reflective exercise focusing on cost conscious care developed for students but easily adapted for residents. Co-authors: C. Daisy Smith, MD, Anthony Artino, PhD, and Norman Berman, MD
View Assessment Tool
Learner Level: Medical Student (clerkship, subinternship students)Program/School: University of Rochester School of Medicine and DentistrySubmitted by: Valerie J. Lang, MDContext: Inpatient, outpatient or EDDescription: 15 HVC fey features examination online cases plus clinical decision making assessment from Med U. Secured cases are scored. Contact info@Med-U.org for access.
View Key Features
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These member submitted tools were reviewed by members of the AAIM High Value Care Work Group.
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