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A high value care curriculum for interns: a description of curricular design, implementation and housestaff feedback
  1. Jason Hom1,
  2. Andre Kumar1,
  3. Kambria H Evans1,
  4. David Svec1,
  5. Ilana Richman2,
  6. Daniel Fang1,
  7. Andrea Smeraglio1,
  8. Marisa Holubar1,
  9. Tyler Johnson1,
  10. Neil Shah3,
  11. Cybele Renault1,
  12. Neera Ahuja1,
  13. Ronald Witteles1,
  14. Stephanie Harman1,
  15. Lisa Shieh1
  1. 1 Department of Medicine, Stanford University School of Medicine, Stanford, California
  2. 2 Center for Health Policy/Primary Care and Outcomes Research, Stanford University, Stanford, California
  3. 3 Department of Pathology, Stanford University School of Medicine, Stanford, California
  1. Correspondence to Dr Jason Hom, Department of Medicine, Division of Hospital Medicine, Stanford University School of Medicine 300 Pasteur Drive, HC007 Stanford, CA 94305, USA; jasonhom{at}


Purpose Most residency programmes do not have a formal high value care curriculum. Our goal was to design and implement a multidisciplinary high value care curriculum specifically targeted at interns.

Design Our curriculum was designed with multidisciplinary input from attendings, fellows and residents at Stanford. Curricular topics were inspired by the American Board of Internal Medicine’s Choosing Wisely campaign, Alliance for Academic Internal Medicine, American College of Physicians and Society of Hospital Medicine. Our topics were as follows: introduction to value-based care; telemetry utilisation; lab ordering; optimal approach to thrombophilia work-ups and fresh frozen plasma use; optimal approach to palliative care referrals; antibiotic stewardship; and optimal approach to imaging for low back pain. Our curriculum was implemented at the Stanford Internal Medicine residency programme over the course of two academic years (2014 and 2015), during which 100 interns participated in our high value care curriculum. After each high value care session, interns were offered the opportunity to complete surveys regarding feedback on the curriculum, self-reported improvements in knowledge, skills and attitudinal module objectives, and quiz-based knowledge assessments.

Results The overall survey response rate was 67.1%. Overall, the material was rated as highly useful on a 5-point Likert scale (mean 4.4, SD 0.6). On average, interns reported a significant improvement in their self-rated knowledge, skills and attitudes after the six seminars (mean improvement 1.6 points, SD 0.4 (95% CI 1.5 to 1.7), p<0.001).

Conclusions We successfully implemented a novel high value care curriculum that specifically targets intern physicians.

  • high value care
  • medical education
  • internal medicine residency

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  • JH and AK contributed equally.

  • Contributors All authors participated in curricular and study conception, design and implementation. All authors participated in survey design and implementation. JH, AK, and KE were responsible for the analysis and interpretation of the survey data. JH, AK, and KE were responsible for drafting of the initial manuscript. All authors provided critical revision of the manuscript for important intellectual content. NA, RW, SH and LS facilitated administrative and material support. All authors provided final approval of the submitted manuscript. JH and AK are responsible for the overall content as guarantors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ’BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.

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