Council on Medical Student Education in Pediatrics

COMSEP Logo

Search This Site

Student Resources

Nb: These goals and objectives may be adapted into your course or session objectives as you try to incorporate teaching about value into the pediatrics clerkship. Many clerkship directors do not feel they have the expertise to teach on these topics. We encourage you to learn a little, and to realize that you probably know more than you think you do. These topics also lend themselves to wonderful teaching opportunities in the clerkship or other pediatric courses for your department chair, hospital COO, health economist, or others.

Goal: That medical students come to understand the concept of high-value care in pediatrics for during both the pediatric clerkship and other pediatric medical school coursework

Objectives: After using one of these tools, medical students will be able to:

  • 1. Explain how their decisions about patient care processes affect costs, expenditures, clinical efficacy and waste. Some specifics regarding value and decision making include:
  • Realizing that diagnostic testing should be ordered only when the test will affect clinical decision making change management, or help the patient get better

    Critically analyze decisions about specific interventions and their comparative effectiveness and overall value to patients

  • Place of care (school, clinic, ED, hospital, ICU)
  • Familiarity with national resources, such as the "Choosing Wisely" campaign lists, article series such as "Bending the value curve" in Hospital Pediatrics
  • Approaches to reduce unnecessary care or "waste"
  • Ethics of unnecessary care or "waste"

  • 2. Describe the basics of healthcare systems and financing including the following terms:
  • Public insurance (Medicare and Medicaid, CHIP)
  • Private insurance models (ACOs, PPOs, HMOs)
  • Bundled payments
  • Fees: Physician fees, facility fees, procedures, testing and diagnostics
  • Methods currently employed to control costs in different delivery systems
  • Barriers to healthcare access
  • Allocation of healthcare resources

  • 3. Apply key concepts from EBM and statistics in screening, prevention and diagnosis, to:
  • To utilize statistics in making appropriate decisions about diagnosis and treatment
  • Consider value, as in the benefit to patient-centered outcomes per dollar spent
  • Determine if improved diagnostic accuracy provides meaningful patient benefit
  • Compare differences in treatment efficacy while also considering costs
  • Identify effective vs. ineffective population-based screening (that which either improves or does not meaningfully improve morbidity or mortality)

    • Recognize that "less is more", that less money spent can result in better health including emotional and psychological health
    • Understand and mitigate against overdiagnosis (identifying and following or treating a "problem" that has no benefit to the patient) and overtreatment (excessive intensity or length of treatment that does not help the patient)
    • Limit the incidence of vulnerable child syndrome that stems from overdiagnosis and overtreatment
    • Incorporate patient/family values concerns into clinical decision-making

    • 4. In building a differential diagnosis, including clinical reasoning instruction about likelihoods of specific diagnoses and staged testing, medical students will be able to:
    • Propose a staged investigation of items on a DDx based on most likely possibilities
    • Limit excessive testing through tiered investigation
    • Determine if getting a test will help the patient get better
    • Explain the risk/benefit ratio of ordering the test
    • Describe how management decisions can best safely limit lengths of inpatient stay or repeat clinic visits
    • Safeguard against premature closure in clinical reasoning

    Learning Activities
    Bibliography