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Erschienen in:

12.02.2019

Imprinting on Clinical Rotations: Multisite Survey of High- and Low-Value Medical Student Behaviors and Relationship with Healthcare Intensity

verfasst von: Andrea N. Leep Hunderfund, MD, MHPE, Stephanie R. Starr, MD, Liselotte N. Dyrbye, MD, MHPE, Elizabeth G. Baxley, MD, Jed D. Gonzalo, MD, MSc, Bonnie M. Miller, MD, Paul George, MD, MHPE, Helen K. Morgan, MD, Bradley L. Allen, MD, PhD, Ari Hoffman, MD, Tonya L. Fancher, MD, MPH, Jay Mandrekar, PhD, Darcy A. Reed, MD, MPH

Erschienen in: Journal of General Internal Medicine | Ausgabe 7/2019

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Abstract

Background

Physician behaviors are important to high-value care, and the learning environment medical students encounter on clinical clerkships may imprint their developing practice patterns.

Objectives

To explore potential imprinting on clinical rotations by (a) describing high- and low-value behaviors among medical students and (b) examining relationships with regional healthcare intensity (HCI).

Design

Multisite cross-sectional survey

Participants

Third- and fourth-year students at nine US medical schools

Main Measures

Survey items measured high-value (n = 10) and low-value (n = 9) student behaviors. Regional HCI was measured using Dartmouth Atlas End-of-Life Chronic Illness Care data (ratio of physician visits per decedent compared with the US average, hospital care intensity index, ratio of medical specialty to primary care physician visits per decedent). Associations between regional HCI and student behaviors were examined using unadjusted and adjusted (controlling for age, sex, and year in school) logistic regression analyses, using median item ratings to summarize reported engagement in high- and low-value behaviors.

Key Results

Of 2623 students invited, 1304 (50%) responded. Many reported trying to determine healthcare costs (1085/1234, 88%), but only 45% (571/1257) reported including cost details in case presentations. Students acknowledged suggesting tests solely to anticipate what their supervisor would want (1143/1220, 94%), show off their ability to generate a broad differential diagnosis (1072/1218, 88%), satisfy curiosity (958/1217, 79%), protect the team from liability (938/1215, 77%), and build clinical experience (533/1217, 44%). Students in higher intensity regions reported significantly more low-value behaviors: each one-unit increase in the ratio of physician visits per decedent increased the odds of reporting low-value behaviors by 20% (OR 1.20, 95% CI 1.04–1.38; P = 0.01).

Conclusions

Third- and fourth-year medical students report engaging in both high- and low-value behaviors, which are related to regional HCI. This underscores the importance of the clinical learning environment and suggests imprinting is already underway during medical school.

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Titel: Imprinting on Clinical Rotations: Multisite Survey of High- and Low-Value Medical Student Behaviors and Relationship with Healthcare Intensity
verfasst von: Andrea N. Leep Hunderfund, MD, MHPE
Stephanie R. Starr, MD
Liselotte N. Dyrbye, MD, MHPE
Elizabeth G. Baxley, MD
Jed D. Gonzalo, MD, MSc
Bonnie M. Miller, MD
Paul George, MD, MHPE
Helen K. Morgan, MD
Bradley L. Allen, MD, PhD
Ari Hoffman, MD
Tonya L. Fancher, MD, MPH
Jay Mandrekar, PhD
Darcy A. Reed, MD, MPH
Publikationsdatum: 12.02.2019
Verlag: Springer US
Erschienen in: Journal of General Internal Medicine / Ausgabe 7/2019
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-019-04828-8

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Abstract

Background

Objectives

Design

Participants

Main Measures

Key Results

Conclusions

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