• Serge B R Mordang, Andrea N Leep Hunderfund, SmeenkFrank W J MFWJMDepartment of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.Department of Pulmonary Medicine, Catharina Hospital, Eindhoven, The Netherlands., StassenLaurents P SLPSDepartment of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands., and Karen D Könings.
• Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands. s.mordang@maastrichtuniversity.nl.
• J Gen Intern Med. 2021 Mar 1; 36 (3): 691698691-698.

BackgroundTraining residents in delivering high-value, cost-conscious care (HVCCC) is crucial for a sustainable healthcare. A supportive learning environment is key. Yet, stakeholders' attitudes toward HVCCC in residents' learning environment are unknown.ObjectiveWe aimed to measure stakeholders' HVCCC attitudes in residents' learning environment, compare these with resident perceptions of their attitudes, and identify factors associated with attitudinal differences among each stakeholder group.DesignWe conducted a cross-sectional survey across the Netherlands between June 2017 and December 2018.ParticipantsParticipants were 312 residents, 305 faculty members, 53 administrators, and 1049 patients from 66 (non)academic hospitals.Main MeasuresRespondents completed the Maastricht HVCCC Attitude Questionnaire (MHAQ), containing three subscales: (1) high-value care, (2) cost incorporation, (3) perceived drawbacks. Additionally, resident respondents estimated the HVCCC attitudes of other stakeholders, and answered questions on job demands and resources. Univariate and multivariate analyses were used to analyze data.Key ResultsAttitudes differed on all subscales: faculty and administrators reported more positive HVCCC attitudes than residents (p ≤ 0.05), while the attitudes of patients were less positive (p ≤ 0.05). Residents underestimated faculty's (p < 0.001) and overestimated patients' HVCCC attitudes (p < 0.001). Increasing age was, among residents and faculty, associated with more positive attitudes toward HVCCC (p ≤ 0.05). Lower perceived health quality was associated with less positive attitudes among patients (p < 0.001). The more autonomy residents perceived, the more positive their HVCCC attitude (p ≤ 0.05).ConclusionsAttitudes toward HVCCC vary among stakeholders in the residency learning environment, and residents misjudge the attitudes of both faculty and patients. Faculty and administrators might improve their support to residents by more explicitly sharing their thoughts and knowledge on HVCCC and granting residents autonomy in clinical practice.

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