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01-03-2021 | Care | Original Research

High-Value, Cost-Conscious Care Attitudes in the Graduate Medical Education Learning Environment: Various Stakeholder Attitudes That Residents Misjudge

Authors: Serge B. R. Mordang, MSc, Andrea N. Leep Hunderfund, MD, MHPE, Frank W. J. M. Smeenk, MD, Laurents P. S. Stassen, MD, Karen D. Könings, PhD

Published in: Journal of General Internal Medicine | Issue 3/2021

Abstract

Background

Training residents in delivering high-value, cost-conscious care (HVCCC) is crucial for a sustainable healthcare. A supportive learning environment is key. Yet, stakeholders’ attitudes toward HVCCC in residents’ learning environment are unknown.

Objective

We aimed to measure stakeholders’ HVCCC attitudes in residents’ learning environment, compare these with resident perceptions of their attitudes, and identify factors associated with attitudinal differences among each stakeholder group.

Design

We conducted a cross-sectional survey across the Netherlands between June 2017 and December 2018.

Participants

Participants were 312 residents, 305 faculty members, 53 administrators, and 1049 patients from 66 (non)academic hospitals.

Main Measures

Respondents completed the Maastricht HVCCC Attitude Questionnaire (MHAQ), containing three subscales: (1) high-value care, (2) cost incorporation, (3) perceived drawbacks. Additionally, resident respondents estimated the HVCCC attitudes of other stakeholders, and answered questions on job demands and resources. Univariate and multivariate analyses were used to analyze data.

Key Results

Attitudes differed on all subscales: faculty and administrators reported more positive HVCCC attitudes than residents (p ≤ 0.05), while the attitudes of patients were less positive (p ≤ 0.05). Residents underestimated faculty’s (p < 0.001) and overestimated patients’ HVCCC attitudes (p < 0.001). Increasing age was, among residents and faculty, associated with more positive attitudes toward HVCCC (p ≤ 0.05). Lower perceived health quality was associated with less positive attitudes among patients (p < 0.001). The more autonomy residents perceived, the more positive their HVCCC attitude (p ≤ 0.05).

Conclusions

Attitudes toward HVCCC vary among stakeholders in the residency learning environment, and residents misjudge the attitudes of both faculty and patients. Faculty and administrators might improve their support to residents by more explicitly sharing their thoughts and knowledge on HVCCC and granting residents autonomy in clinical practice.

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Title: High-Value, Cost-Conscious Care Attitudes in the Graduate Medical Education Learning Environment: Various Stakeholder Attitudes That Residents Misjudge
Authors: Serge B. R. Mordang, MSc
Andrea N. Leep Hunderfund, MD, MHPE
Frank W. J. M. Smeenk, MD
Laurents P. S. Stassen, MD
Karen D. Könings, PhD
Publication date: 01-03-2021
Publisher: Springer International Publishing
Keyword: Care
Published in: Journal of General Internal Medicine / Issue 3/2021
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-020-06261-8

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Abstract

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Objective

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Participants

Main Measures

Key Results

Conclusions

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