Study Assesses Residents' Knowledge of Value

The American College of Physicians (ACP) says more studies are needed to find out how well medical residents understand and implement high-value care concepts.

ACP looked into the matter in a paper published this week in the Annals of Internal Medicine. The college’s High-Value Care (HVC) initiative is designed to ensure residents understand the benefits, harms, and costs of treatment options. The ultimate goal is to improve patient care and eliminate waste.

In order to assess whether those principles were getting through to residents, researchers looked at a sub-set of questions within the Internal Medicine In-Training Examination (IM-ITE). Thirty-eight of the 340 questions on the exam were deemed relevant and were used to create an HVC sub-score.

“While HVC sub-scores correlated strongly with overall IM-ITE performance, we did find some association between medical resident sub-scores and the care intensity at the training hospital,” said Cynthia Smith, MD, a senior physician educator at ACP.

Specifically, the study found a “modest inverse relationship” between HVC scores and a hospital’s care intensity.

Hospital care intensity was measured using the Dartmouth Atlas index, a composite measure of hospital stays and inpatient physician visits for Medicare patients in the last years of life.

The most common HVC competency found in the study was “managing conservatively when appropriate,” ACP reported. Examples include giving treatments time to work before moving on to the next approach and limiting diagnostic testing.

Still, ACP said its study shouldn’t be viewed as a conclusive report about the utilization of HVC practices. The college said more research is needed “to evaluate how well HVC sub-scores approximate actual resident and independent practice, and focus on the development of stronger tools for measuring HVC in practice.”

The study included IM-ITE scores from 362 internal medicine residency programs in the US.