LAUSR

What problems were addressed? Medical education is still evolving to meet the challenges posed by the modern health care system. Physicians are responsible for 87% of the estimated US$765 billion annual health care waste in the United States, yet multiple studies have demonstrated physicians’ lack of knowledge about costs associated with the tests and treatments they order. To address these challenges, multiple national initiatives have suggested the formal integration of value-based care into medical curricula. What was tried? Aiming to promote a robust highvalue teaching curriculum, we implemented a novel ‘just-in-time’ online tool to teach high-value care practices to medical students. Our tool, designed based on baseline student survey data and named ‘Value Check’, embedded evidence-backed, valuebased clinical data into a structured clinical reasoning framework. Our goal was to assist student decision making in their efforts to formulate highvalue diagnostic–therapeutic approaches to commonly encountered clinical problems and build on a recently implemented high-value care curriculum in the pre-clerkship. The online tool functions as a data repository with direct access to categorised clinical reasoning and decision-making methodology, high-value care guidelines, expert opinions and cost-effectiveness data. Using an online application software platform Prezi (Prezi Inc., San Francisco, CA, USA), we generated the tool content based on 13 common conditions encountered within the acute care service at our institution, with plans to assess utilisation via direct user surveys and observation of behaviour on teaching rounds. In order to promote utilisation, we tied our project to the concurrent implementation of newly required entrustable professional activities (EPA) for students, one of which involves valuebased care (EPA-3). We chose a ‘just-in-time’ framework with educational materials tailored to faculty members (attending physicians and medical students), aiming to promote real-time use of the tool during teaching rounds and EPA-3 assessment. We disseminated information about our tool via email, as part of the orientation the students receive during the EPA process. We followed implementation with recurring medical student surveys regarding EPAs and the high-value care curriculum. What lessons were learned? Our predominant challenge was utilisation by faculty members (attending physicians and medical students). Linking our tool with the required EPA assessment was helpful in solidifying student need. However, the transition to EPA-based assessments was difficult for some attending physicians given the change in philosophy and direct observation requirements. We believe those slow to adopt the new assessment style were also reluctant to utilise our high-value care tool. We also neglected to conduct a sufficient needs assessment for the attending physicians. Despite the recent increased attention given to high-value care in the medical education literature, not all physicians fully embrace the need for valuebased, cost-conscious care, and even more lack formal or recent training in this area. A ‘just-intime’ approach is dependent on some degree of prior knowledge and a reliable, consistent need. Although national and institutional survey data suggest students want access to innovative high-value care resources such as our tool, this need was not sufficient, in our case, to overcome a lack of faculty development and institutional resistance to change. On reflection, our project highlights the importance of an accurate needs assessment and an implementation model that matches the educational needs of all stakeholders.