HealthValueLab – The Implementation of Case-Based Learning in Medical School Curricula
Overview
SUMMARY
Case-based learning provides a flexible, interactive mechanism for integrating High-Value Care (HVC) principles into medical education.
PURPOSE
To utilize the HealthValueLab’s library of HVC cases to support practical, evidence-informed implementation of HVC teaching. These cases are designed for preclinical clinical reasoning courses, didactics, and student-led learning to introduce value-based considerations to learners who already possess a baseline understanding of medical fundamentals.
WHY IMPLEMENT
To bridge the disconnect between classroom instruction and clinical environments. This curriculum allows students to embed value-based considerations directly into activities such as problem representation, differential diagnosis construction, and test selection. By visualizing relative costs, diagnostic yield, and downstream consequences, learners develop practical skills in risk stratification and decision-making under uncertainty.
STEPS FOR IMPLEMENTATION
Successfully deploying a HealthValueLab case requires identifying the right venue, selecting an optimal clinical scenario, and facilitating a dynamic, interactive session.
Step 1: Identifying the Right Educational Context and Faculty Partner
- Preclinical Education: Preclinical courses focused on clinical reasoning, problem representation, and diagnostic schema development represent the most direct entry point. Integrate prompts about pretest probability and diagnostic yield directly into these existing case discussions.
- Clinical Education: Clerkships offer critical opportunities to reinforce HVC principles through real patient care. Encourage students to articulate a value or safety consideration during oral or written SOAP presentations. Faculty modeling explicit discussion of diagnostic thresholds during rounds can be important for shaping student interpretation.
- Co-Curricular and Student-Led Initiatives: Student-led initiatives can strengthen alignment between formal curricula and clinical care. Coordinate with faculty mentors to include student-facilitated case discussions, provide opportunities for peer-to-peer education, and formally recognize clinicians who model high-value care.
Step 2: Select and Appropriate Clinical Case
- Although new cases are being written, the HealthValueLab currently offers three interactive cases: Chest Pain, Headache, and Pre-Operative Evaluation. To maximize their effectiveness, deploy the case that best aligns with your learners’ current clinical block or stage of training.
- For instance, the Chest Pain case can explore probabilistic reasoning regarding pulmonary embolisms and acute coronary syndrome. The Headache case can discuss imaging thresholds and downstream consequences of incidental findings. The Pre-Operative Evaluation case can prepare students for surgical rotations and preoperative testing stewardship.
Step 3: Introduce the Case, Establish the Scenario, and Develop Problem Representation
- Divide the audience into small groups to encourage peer-to-peer collaboration.
- Present the initial patient presentation, history, and basic physical exam findings.
- Stop the presentation at multiple points as the case progresses, such as before any labs or imaging are revealed. Give groups time to draft initial and updated problem representation. Asking groups to share their representations out loud can establish the baseline clinical picture.
Step 4: Facilitate Iterative Diagnostic Triage
- Before allowing students to order a broad panel of tests on the interactive website, ask them to prioritize and justify their selections.
- Have groups sort their proposed diagnostics into three distinct categories:
- Absolutely Indicated: Necessary to manage and treat the clinical scenario.
- Not Indicated / Minimal Harm: Would not change management but poses minimal physical risk to the patient.
- Not Indicated / May Harm: Should not be done and exposes the patient to unnecessary risk (e.g., radiation from unnecessary imaging).
- Prompt students to utilize validated Clinical Decision Rules (e.g., Wells’ Criteria, PERC, etc.) to objectively justify why certain tests can be safely deferred.
Step 5: Reveal, Reflect, and Evaluate
- Reveal the test results incrementally based on what the students “ordered.”
- Conclude the case by having students review the platform’s “Expert Mode” to receive personalized feedback on their diagnostic efficiency. Ask the learners to reflect on the generated itemized receipt detailing the financial costs of their diagnostic approach. Prompt the group with questions such as:
- Did any test you ordered change management or confirm what you already knew?
- How much did your diagnostic workup cost?
- Could you achieve the same diagnostic confidence with fewer tests?
INTERESTED IN CREATING YOUR OWN CASE?
While the HealthValueLab provides a library of ready-to-use cases, we are always looking to expand our curriculum! If you are interested in helping with the design of a new High-Value Care case, the HealthValueLab team is happy to help. We encourage students to collaborate with classmates, faculty mentors, and various educational partners to build out new clinical scenarios.
Please reach out to the team via [email protected] to get started.
BEST PRACTICES & LESSONS LEARNED
- Silence is okay. During designated pause points, allow learners time to struggle with uncertainty. HVC relies on learning to pause and considering pretest probability rather than reflexively ordering algorithms.
- Utilize time limits (e.g., 5-10 minutes) for small group breakouts to stimulate the time pressures of a real clinical environment.
- Frame cost-conscious decision-making as an extension of probabilistic reasoning and patient safety, rather than strictly as financial “cost containment”. Good care isn’t about doing more; it is about doing what matters.
- Targeted, well-aligned entry points (like integrating a single case into an existing clinical reasoning course or block) are more effective than broad implementation efforts.
IMPACT STATEMENTS
“This case helped me realize that ordering tests can be inefficient and can cause real financial harm to our patients and the healthcare system.” – Medical Student
“I feel more confident initiating conversations about the cost of care and explaining to patients why certain tests might be unnecessary.” – Medical Student
“The HealthValueLab provides the interactive, iterative reinforcement students need to translate more theoretical value-based concepts into their future clinical practice.” – Faculty
CHAMPIONS
Jonathan Gong, Medical Student – UC San Diego
Melanie Chuong. Medical Student at UC San Diego