High Value, Cost-Conscious Care: Perspective of Pediatric Faculty and Residents

High and rising US healthcare costs are unsustainable. The American College of Physicians has defined the term “high value, cost-conscious care” (HVCC) as care that promotes optimal patient outcomes while reducing unnecessary cost. Teaching around HVCC is essential to promote this practice, yet little educational research has assessed the perspective of pediatric residents and faculty with regard to training and teaching HVCC. We surveyed all pediatric residents and teaching faculty in two large academic medical centers. Our surveys addressed two primary research questions: 1) How do faculty teach HVCC and what barriers exist? 2) How do residents perceive HVCC training and what types of curriculum do they prefer? We used descriptive statistics for data analysis. We received responses from 51% of faculty (n=128) and 60% of residents (n=73). A majority of faculty and residents agreed that GME has the responsibility to slow rising healthcare costs (73%, 80%), and that every pediatric training program should have a formal HVCC curriculum (89%, 91%). Residents felt the most important ways of learning HVCC were through informal discussion on rounds (60%), increased transparency of cost data (65%), formal didactic sessions (29%) and chart review (29%). Only 26% of residents felt comfortable practicing HVCC. Faculty and residents identified lack of training or knowledge (50%, 53%) and lack of hospital support (73%, 69%) as the biggest barriers to practicing HVCC. Over 85% of residents also reported lack of attending involvement as a barrier. While most faculty were comfortable practicing HVCC (55%), 83% of faculty felt they would benefit from faculty development to better teach residents. Residents and faculty both agree that HVCC is important and that training institutions have a responsibility to help curb the rising cost of healthcare. However, lack of role modeling by faculty is a major concern. A curriculum that combines informal discussion on rounds with formal didactic sessions and chart review is important, but faculty development, hospital support, and transparency of data will be key for training programs.