• Vanessa Ford, Helena Frischtak, Joesph R Wiencek, and Andrew S Parsons.
• From the Department of Pediatrics, Emory University, Atlanta, Georgia, the Department of Family Medicine, Contra Costa Regional Medical Center, Martinez, California, the Department of Pathology, Vanderbilt University, Nashville, Tennessee, and the Department of Medicine, University of Virginia, Charlottesville.
• South. Med. J. 2021 Dec 1; 114 (12): 797-800.

ObjectiveOne-third of all healthcare dollars are wasted, primarily in the form of clinician-ordered unnecessary diagnostic tests and treatments. Medical education has likely played a central role in the creation and perpetuation of this problem. We aimed to create a curriculum for medical students to promote their contribution to high-value care conversations in the clinical environment.MethodsAt a large university medical center between March 2017 and February 2018, we implemented a 3-phase curriculum combining multimodal educational initiatives with individual and group reflection for third-year medical students during their 12-week long Internal Medicine clerkship rotation. Students were asked to identify examples of clinical decision making that lacked attention to high-value care, propose solutions to the identified situation, and pinpoint barriers to the implementation of effective solutions using a structured reflection framework and then participate in a debrief debate with fellow students. To assess the curriculum, reflective narratives were coded by frequency and codes were compared with one another and with relevant high-value care literature to identify patterns and themes.ResultsIn total, 151 medical students participated in phase 1 and 119 in phase 3. For phase 2, 126 reflective narratives (94.7% participation rate) comprised 226 problems, 280 solutions, and 179 barriers.ConclusionsWhen provided appropriate resources, medical students are able to identify relevant examples of low-value care, downstream solutions, and barriers to implementation through a structured reflection curriculum comprising written narratives and in-person debate.

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