Utilizing Kern's Six-Step Approach to Develop a Novel Curriculum for Enhancing Pediatric Resident Understanding of...

Although cost awareness and advocacy for quality care are core GME competencies, high-value care (HVC) curricula remain limited. Growing evidence shows families increasingly want cost conversations with providers, yet many providers feel ill-equipped. We developed a curriculum to increase pediatric residents' understanding of cost determination and confidence discussing resources with families.

Using Kern's six-step approach, we created a two-session curriculum. Session 1 explores how health care charges translate to patient financial responsibility. Session 2 is a simulation in which participants make decisions from the caregiver perspective while incurring costs under randomly assigned insurance plans. Participants completed a postsession survey (session 1) and pre- and postsession evaluations (session 2). We used Wilcoxon signed-rank and chi-square tests to determine significant differences (p < .05).

Seventy-four residents participated between 2022 and 2024. Most respondents rated each session as useful (≥98%). All reported improved understanding of cost determination after the first session. Simulation participation bolstered confidence in supporting families experiencing financial strain (increasing from 5% to 83%; p < .01). Ninety-six percent found the simulation format enhanced learning, and 87% planned to more frequently discuss costs with patients.

This curriculum addresses a critical gap in HVC and health systems education by centering the patient's financial experience. The two-session format of a transparent explanation of costs, paired with a simulation experience, improved participants' knowledge, self-efficacy in advocacy, and intent to practice cost-conscious care. Next steps include measuring knowledge retention, and having residents review actual bills issued for their own patients.