• Caroline L Matchett, Hannah C Nordhues, M Usmaan Bashir, Stephen P Merry, and Adam P Sawatsky.
• Internal Medicine Residency Program, Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA. matchett.caroline@mayo.edu.
• J Gen Intern Med. 2023 Jan 1; 38 (1): 424842-48.

BackgroundEstimates suggest 30% of health care expenditures are wasteful. This has led to increased educational interventions in graduate medical education (GME) training aimed to prepare residents for high value, cost-conscious practice. International health electives (IHE) are widely available in GME training and may be provide trainees a unique perspective on principles related to high value, cost-conscious care (HVCCC).ObjectiveThe purpose of this study was to explore how trainee reflections on IHE experiences offer insight into HVCCC.DesignThe authors conducted an applied thematic analysis of narrative reflective reports of GME trainees' IHE experiences to characterize their perceptions of HVCCC.ParticipantsThe Mayo International Health Program (MIHP) supports residents and fellows from all specialties across all Mayo Clinic sites. We included 546 MIHP participants from 2001 to 2020.ApproachThe authors collected post-elective narrative reports from all MIHP participants. Reflections were coded and themes were organized into model for transformative learning during IHEs, focusing on HVCCC.Key ResultsGME trainees across 24 different medical specialties participated in IHEs in 73 different countries. Three components of transformative learning were identified: disorienting dilemma, critical reflection, and commitment to behavior change. Within the component of critical reflection, three topics related to HVCCC were identified: cost transparency, resource stewardship, and reduced fear of litigation. Transformation was demonstrated through reflection on future behavioral change, including cost-aware practice, stepwise approach to health care, and greater reliance on clinical skills.ConclusionsIHEs provide rich experiences for transformative learning and reflection on HVCCC. These experiences may help shape trainees' ideology of and commitment to HVCCC practices.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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