Physician Experiences With High Value Care in Internal Medicine Residency: Mixed-Methods Study of 2003-2013 Residency Graduates

In Teaching and Learning in Medicine, Kira Ryskina and colleagues, including Judy Shea and Judith Long, assess U.S physicians’ exposure to teaching about high-value care during their residency training. High health care costs and relatively poor health outcomes have led to calls to improve the teaching of high value care, and numerous interventions in graduate medical education have been implemented over the past decade. However, there has been little evaluation of their impact on physicians’ training experience and preparedness for practice.

The authors conducted a cross-sectional survey of internists with residencies completed between 2003 and 2013 asking questions regarding exposure to teaching about high-value care, overtreatment guidelines, and shared decision-making. Of the 50.2 percent of responding physicians, less than one fourth reported being frequently exposed to teaching about high-value care. Only 43.8% of respondents felt prepared to use overtreatment guidelines in conversations with patients, whereas 85 percent felt prepared to both participate in shared decision making, and practice generic prescribing. Physicians who completed residency more recently were more likely to report practicing generic prescribing, and feeling well prepared to use overtreatment guidelines in conversations with patients. The authors conclude that, despite some exposure to high-value care training, many U.S internists are inadequately prepared for discussion with patients about cost and using overtreatment guidelines.