Putting Principles into Practice: Pediatric Trainee Experiences in Discussing and Practicing High-Value Care

High-value care (HVC) aims to improve patient outcomes by optimizing clinical benefit while minimizing costs and harms; however there is little formal HVC training in pediatric residency and the "hidden curriculum" may reinforce low-value practices. We aimed to: 1) Describe the experience of senior residents with discussing and practicing HVC; 2) Explore factors that facilitate or impede these discussions; and 3) Understand the influence of the training experience on attitudes and intended future practice of HVC.

This multicenter qualitative study was conducted at three University-Affiliated children's hospitals in 2022, using a constructivist approach. We developed focus group questions based on a literature review to address our aims. We conducted four focus groups with senior pediatric residents and performed a thematic analysis.

Eighteen senior residents participated in the study. We developed five distinct themes: 1) Residents learn to deliver value across different environments and HVC cultures, 2) Intentional conversations cultivate HVC, 3) Role-modeling promotes value for trainees and families, 4) Barriers to HVC affect trainee motivation and practice of value, 5) Lack of autonomy to deliver HVC leads to trainee emotional and moral distress.

Senior residents are motivated to learn HVC through explicit discussions and role-modeling by supervisors, and they seek to role-model HVC as team leaders themselves. However, lack of trainee autonomy and frequent barriers to HVC can inhibit learning and contribute to moral distress and demotivation. Developing faculty to role model HVC and communication strategies with patients and families may benefit resident education and practice.