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

Area of Science:

• Medical Education
• Healthcare Management
• Patient Outcomes

Background:

• High-value care (HVC) optimizes patient outcomes by maximizing benefits and minimizing costs/harms.
• Pediatric residency programs have limited formal HVC training.
• The "hidden curriculum" may inadvertently promote low-value practices.

Purpose of the Study:

• Describe senior residents' experiences with discussing and practicing HVC.
• Explore factors influencing HVC discussions.
• Understand how training impacts HVC attitudes and future practice.

Main Methods:

• Multicenter qualitative study at 3 university-affiliated children's hospitals (2022).
• Constructivist approach with focus groups and thematic analysis.
• Four focus groups conducted with 18 senior pediatric residents.

Main Results:

• Residents learn HVC across diverse settings and cultures.
• Intentional conversations and supervisor role-modeling cultivate HVC.
• Barriers, lack of autonomy, and limited role-modeling impede HVC learning and cause distress.

Conclusions:

• Senior residents are motivated to learn and practice HVC via explicit training and role-modeling.
• Lack of autonomy and systemic barriers negatively impact resident learning and well-being.
• Enhancing faculty role-modeling and patient communication strategies is crucial for effective HVC education.