ABSTRACT
OBJECTIVES: Stimulating the active participation of residents in projects with societally relevant healthcare themes, such as value-based healthcare (VBHC), can be a strategy to enhance competency development. Canadian Medical Education Directions for Specialists (CanMEDS) competencies such as leader and scholar are important skills for all doctors. In this study, we hypothesise that when residents conduct a VBHC project, CanMEDS competencies are developed. There is the added value of gaining knowledge about VBHC. DESIGN: An explorative mixed-methods study assessing residents' self-perceived learning effects of conducting VBHC projects according to three main components: (1) CanMEDS competency development, (2) recognition of VBHC dilemmas in clinical practice, and (3) potential facilitators for and barriers to implementing a VBHC project. We triangulated data resulting from qualitative analyses of: (a) text-based summaries of VBHC projects by residents and (b) semistructured interviews with residents who conducted these projects. SETTING: Academic and non-academic hospitals in the Netherlands. PARTICIPANTS: Out of 63 text-based summaries from residents, 56 were selected; and out of 19 eligible residents, 11 were selected for semistructured interviews and were included in the final analysis. RESULTS: Regarding CanMEDS competency development, the competencies 'leader', 'communicator' and 'collaborator' scored the highest. Opportunities to recognise VBHC dilemmas in practice were mainly stimulated by analysing healthcare practices from different perspectives, and by learning how to define costs and relate them to outcomes. Finally, implementation of VBHC projects is facilitated by a thorough investigation of a VBHC dilemma combined with an in-depth stakeholder analysis. CONCLUSION: In medical residency training programmes, competency development through active participation in projects with societally relevant healthcare themes-such as VBHC-was found to be a promising strategy. From a resident's perspective, combining a thorough investigation of the VBHC dilemma with an in-depth stakeholder analysis is key to the successful implementation of a VBHC project.
Subject(s)
Internship and Residency , Physicians , Canada , Clinical Competence , Delivery of Health Care , HumansABSTRACT
Resource stewardship and reducing low-value care have emerged as urgent priorities for health care delivery systems worldwide. However, few medical schools' curricula include adequate content to allow learners to master the knowledge, skills, and attitudes needed to contribute to this transformation toward value-based health care. This article describes a program to launch student-led curriculum enhancement initiatives in 7 countries. The program, called STARS (Students and Trainees Advocating for Resource Stewardship), was inspired by Choosing Wisely, a campaign by the American Board of Internal Medicine Foundation that seeks to promote conversations on avoiding unnecessary medical tests, treatments, and procedures.The initial STARS model, which originated in Canada in 2015, included a leadership summit, where students from multiple medical schools learned about Choosing Wisely principles, leadership, and advocacy. These students then led grassroots efforts at their local medical schools with faculty and other students to raise awareness and advocate for changes related to resource stewardship. Student-led efforts resulted in the integration of Choosing Wisely principles into case-based learning, the creation of student interest groups and electives, the launch of social media campaigns, and the organization of special presentations by local experts.The rapid spread of similar programs in 6 other countries (Italy, Japan, the Netherlands, New Zealand, Norway, and the United States) by 2018 suggests that STARS resonates across multiple settings and signals the potential for such a model to advance other important areas in medical education. This article documents results and lessons learned from the first 4 years of the program.
