Implementation of an educational intervention to improve medical student cost awareness: a prospective cohort study

Sarah D Tait; Sachiko M Oshima; Harold J Leeras; Alexander Gunn; Melissa Sarver; Funda Gunes; Rachel A Greenup

doi:10.1186/s12909-023-04038-1

Implementation of an educational intervention to improve medical student cost awareness: a prospective cohort study

BMC Med Educ. 2023 Jan 30;23(1):73. doi: 10.1186/s12909-023-04038-1.

Authors

Sarah D Tait^#¹, Sachiko M Oshima^#², Harold J Leeras³, Alexander Gunn⁴, Melissa Sarver⁴, Funda Gunes⁵, Rachel A Greenup⁶

Affiliations

¹ Department of Internal Medicine, Massachusetts General Hospital, MA, Boston, USA.
² Department of Internal Medicine, Duke University School of Medicine, NC, Durham, USA.
³ Department of Surgery, Duke University School of Medicine, NC, Durham, USA.
⁴ Duke University School of Medicine, NC, Durham, USA.
⁵ Department of Statistical Science, Duke University, NC, Durham, USA.
⁶ Department of Surgery, Yale University, 310 Cedar Street, LH 118, 60510, New Haven, Connecticut, USA. rachel.greenup@yale.edu.

^# Contributed equally.

Abstract

Background: In the context of rising healthcare costs, formal education on treatment-related financial hardship is lacking in many medical schools, leaving future physicians undereducated and unprepared to engage in high-value care.

Method: We performed a prospective cohort study to characterize medical student knowledge regarding treatment-related financial hardship from 2019 to 2020 and 2020-2021, with the latter cohort receiving a targeted educational intervention to increase cost awareness. Using Kirkpatrick's four-level training evaluation model, survey data was analyzed to characterize the acceptability of the intervention and the impact of the intervention on student knowledge, attitudes, and self-reported preparedness to engage in cost-conscious care.

Results: Overall, N = 142 medical students completed the study survey; 61 (47.3%) in the non-intervention arm and 81 (66.4%) in the intervention arm. Of the 81 who completed the baseline survey in the intervention arm, 65 (80.2%) completed the immediate post-intervention survey and 39 (48.1%) completed the two-month post-intervention survey. Following the educational intervention, students reported a significantly increased understanding of common financial terms, access to cost-related resources, and level of comfort and preparedness in engaging in discussions around cost compared to their pre-intervention responses. The majority of participants (97.4%) reported that they would recommend the intervention to future students. A greater proportion of financially stressed students reported considering patient costs when making treatment decisions compared to their non-financially stressed peers.

Conclusions: Targeted educational interventions to increase cost awareness have the potential to improve both medical student knowledge and preparedness to engage in cost-conscious care. Student financial stress may impact high-value care practices. Robust curricula on high-value care, including treatment-related financial hardship, should be formalized and universal within medical school training.

Keywords: Financial hardship; Financial toxicity; High-value care; Medical education.

MeSH terms

Curriculum
Health Care Costs
Humans
Physicians*
Prospective Studies
Students, Medical*

Grants and funding

UL1 TR001863/TR/NCATS NIH HHS/United States