Using Online Simulation of Pediatric Musculoskeletal Cases to Evaluate How Knowledge of Costs Affects Diagnostic Workup
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ORIGINAL RESEARCH
Using Online Simulation of Pediatric Musculoskeletal Cases to Evaluate How Knowledge of Costs Affects Diagnostic Workup Allison T. Yip 1 & Simrat Morris 2 & Nilam D. Patel 1 & Marc Buchner 3 & Angela Byun Robinson 1,4
# International Association of Medical Science Educators 2020
Abstract Background Rising healthcare costs have emphasized the need to teach cost-conscious care in graduate medical education. Objective To teach high-value care and diagnostic evaluation of pediatric musculoskeletal complaints to residents and rotating medical students through online cases. Methods Six online cases were developed and tested at the University Hospitals Cleveland Medical Center. Learners completed modules in one of two groups, those who saw itemized costs of diagnostic tests or those who did not. All learners completed a post-simulation survey. Measured outcomes included presumed diagnosis, cost of evaluation, tests ordered, and perceptions toward high-value care. Simulation outcomes were assessed using paired t-tests. Survey data was analyzed with Chi-squared tests. Outcomes separated by training year were analyzed using ANOVA and post-hoc Tukey test. Results Thirty-nine residents and medical students participated and were randomly assigned to complete the cases with costs (n = 19) or no costs (n = 20) displayed during workup. Overall, learners who saw costs spent less money on diagnostics ($1511.11 mean per learner versus $2311.35, p = 0.01). Arrival at the correct diagnosis was associated with lower costs in 3 of 6 cases. When compared to the no cost group, learners in the costs group reported feeling more knowledgeable about the price of diagnostic tests (p = 0.04) and were more likely to factor costs into their practice moving forward (p = 0.03). Third year or above residents demonstrated a statically significant increase in correctly diagnosed cases as opposed to medical students. Conclusions Interventions that challenge learners to integrate costs into decision-making can potentially change future practice. Keywords High-value care . Online simulated cases . Pediatric musculoskeletal complaints . Residency . Pediatrics
Prior Abstract and Podium Presentation: This project was presented as an oral presentation during the 2018 American College of Rheumatology Annual Meeting, October 20–24, 2018 in Chicago, IL. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40670-020-00932-1) contains supplementary material, which is available to authorized users. * Angela Byun Robinson [email protected] 1
Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH 44106, USA
2
Division of Pediatric Rheumatology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
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Department of Electrical Engineering & Computer Science, Case Western Reserve School of Engineering, 2095 Martin Luther King Jr. Drive, Cleveland, OH 44106, USA Cleveland Clinic Children’s Hospital, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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