Effect of cost exposure on medical students’ preferred mammography screening strategies: A randomized comparison

Abstract

Introduction: Many high value care educational interventions have focused on shaping clinical decision-making for individual patients. Few have investigated how trainees integrate cost information into recommendations within a public health context.

Methods: Third-year medical students at the University of California San Francisco participated in a small group on benefits and harms of breast cancer screening. We randomly assigned half of small groups to view estimated total costs of different screening strategies. Students selected a screening strategy for coverage by a publicly funded program and one they would recommend to a hypothetical patient. We used the chi-square test for independence and chi-square test for trend to compare proportions.

Results: A total of 267 third-year medical students participated. Exposure to costs was associated with selection of significantly less intensive screening strategies for coverage by a publicly funded program (p < 0.05). We found no significant differences in perspectives that involved recommendations for individual patients.

Discussion: Students weigh cost considerations more heavily when making decisions about populations, rather than individual hypothetical patients. We suggest that it may be easier for students to relate cost considerations to populations. Initial curricular activities can be framed from this perspective with subsequent activities focusing on individual patient care.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

High-value care: Care that involves assessing benefits, harms, and costs of an intervention, and refers to care in which the net benefit justify the costs. High-value care also encompasses eliminating interventions that provide little to no benefit (Owens et al. 2011).

Additional information

Notes on contributors

Clarice Nguyen

Clarice Nguyen, MD, is a graduate of UCSF School of Medicine and a resident in Pediatrics and Anesthesiology.

George F. Sawaya

George F. Sawaya, MD, is a Professor of Obstetrics, Gynecology and Reproductive Sciences and Epidemiology & Biostatistics at UCSF and Education Lead at the UCSF Center for Healthcare Value.

Ari Hoffman

Ari Hoffman, MD, is an Assistant Clinical Professor of Internal Medicine and Value Improvement Director for Hospital Medicine at UCSF. He is affiliated faculty at the UCSF Philip R. Lee Institute of Health Policy Studies.