Peer-reviewed article
Putting Principles into Practice: Pediatric Trainee Experiences in Discussing and Practicing High-Value Care.
Laura Thompson-Martin, Jimmy Beck, L Barry Seltz, Michael J Tchou, Emma Nathaniel et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study explores how pediatric medical residents learn about and practice high-value care (delivering good outcomes at lower cost and harm) in hospital training programs. The research found that residents are motivated to learn high-value care through explicit teaching and role-modeling by supervisors, but face barriers including lack of autonomy and institutional practices that discourage value-conscious medicine. The study recommends better training of faculty to model and teach these practices to trainees.
Key points
- Residents learn high-value care through intentional conversations and role-modeling by supervisors
- Lack of trainee autonomy to practice high-value care leads to emotional and moral distress
- Institutional culture and barriers significantly affect trainee motivation to practice value-conscious medicine
- Senior residents seek to become role models for high-value care as team leaders
- Faculty development in role-modeling high-value care and communication strategies is recommended
Limitations
This qualitative study describes trainee experiences and perceptions at three US children's hospitals and does not measure actual patient outcomes or the effectiveness of high-value care practices on child health. The findings may not generalize beyond academic pediatric settings in high-income countries.
Abstract
OBJECTIVES: High-value care (HVC) aims to improve patient outcomes by optimizing clinical benefit while minimizing costs and harms; however there is little formal HVC training in pediatric residency and the "hidden curriculum" may reinforce low-value practices. We aimed to: 1) Describe the experience of senior residents with discussing and practicing HVC; 2) Explore factors that facilitate or impede these discussions; and 3) Understand the influence of the training experience on attitudes and intended future practice of HVC. METHODS: This multicenter qualitative study was conducted at three University-Affiliated children's hospitals in 2022, using a constructivist approach. We developed focus group questions based on a literature review to address our aims. We conducted four focus groups with senior pediatric residents and performed a thematic analysis. RESULTS: Eighteen senior residents participated in the study. We developed five distinct themes: 1) Residents learn to deliver value across different environments and HVC cultures, 2) Intentional conversations cultivate HVC, 3) Role-modeling promotes value for trainees and families, 4) Barriers to HVC affect trainee motivation and practice of value, 5) Lack of autonomy to deliver HVC leads to trainee emotional and moral distress. CONCLUSION: Senior residents are motivated to learn HVC through explicit discussions and role-modeling by supervisors, and they seek to role-model HVC as team leaders themselves. However, lack of trainee autonomy and frequent barriers to HVC can inhibit learning and contribute to moral distress and demotivation. Developing faculty to role model HVC and communication strategies with patients and families may benefit resident education and practice.