• Hunter Niehus, Ali Noel Gunesch, Nina Rodriguez, Julianna Khoury, Annie Ma, Nina Gu, Thy Cao, Megan Muller, Christopher Moriates, Anne S Linker, Micah Prochaska, David Fish, Glenn Moulder, Melissa Stephens, Patricia A Carney, and Andrea Smeraglio.
• Department of Medicine, Oregon Health & Science University School of Medicine, Portland, OR, USA.
• J Gen Intern Med. 2024 May 6.

BackgroundBecause physician practices contribute to national healthcare expenditures, initiatives aimed at educating physicians about high-value cost-conscious care (HVCCC) are important. Prior studies suggest that the training environment influences physician attitudes and behaviors towards HVCCC.ObjectiveTo explore the relationship between medical student experiences and HVCCC attitudes.DesignQuantitative and qualitative analysis of a multi-institutional survey.ParticipantsMedical students from nine US medical schools.ApproachA 44-item survey that included the Maastricht HVCCC Attitudes Questionnaire, a validated tool for assessing HVCCC attitudes, was administered electronically. Attitudinal domains of high-value care (HVC), cost incorporation (CI), and perceived drawbacks (PD) were compared using one-way ANOVA among students with a range of exposures. Open text responses inviting participants to reflect on their attitudes were analyzed using classical content analysis.Key ResultsA total of 740 students completed the survey (response rate 15%). Students pursuing a "continuity-oriented" specialty held more favorable attitudes towards HVCCC than those pursuing "technique-oriented" specialties (HVC sub-score = 3.20 vs. 3.06; p = 0.005, CI sub-score = 2.83 vs. 2.74; p < 0.001). Qualitative analyses revealed personal, educational, and professional experiences shape students' HVCCC attitudes, with similar experiences interpreted differently leading to both more and less favorable attitudes.ConclusionStudents pursuing specialties with longitudinal patient contact may be more enthusiastic about practicing high-value care. Life experiences before and during medical school shape these attitudes, and complex interactions between these forces drive student perceptions of HVCCC.© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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