Measuring Value in Internal Medicine Residency Training Hospitals Using Publicly Reported Measures

Am J Med Qual. 2018 Nov/Dec;33(6):604-613. doi: 10.1177/1062860618767312. Epub 2018 Apr 11.


Graduate medical education (GME) lacks measures of resident preparation for high-quality, cost-conscious practice. The authors used publicly reported teaching hospital value measures to compare internal medicine residency programs on high-value care training and to validate these measures against program director perceptions of value. Program-level value training scores were constructed using Centers for Medicare & Medicaid Services Value-Based Purchasing (VBP) Program hospital quality and cost-efficiency data. Correlations with Association of Program Directors in Internal Medicine Annual Survey high-value care training measures were examined using logistic regression. For every point increase in program-level VBP score, residency directors were more likely to agree that GME programs have a responsibility to contain health care costs (adjusted odds ratio [aOR] 1.18, P = .04), their faculty model high-value care (aOR 1.07, P = .03), and residents are prepared to make high-value medical decisions (aOR 1.07, P = .09). Publicly reported clinical data offer valid measures of GME value training.

Keywords: cost-effectiveness; graduate medical education; quality; value.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Cost-Benefit Analysis
  • Disclosure*
  • Health Care Surveys
  • Hospitals, Teaching / economics
  • Hospitals, Teaching / standards*
  • Humans
  • Internal Medicine / education*
  • Internship and Residency*
  • Logistic Models
  • Program Evaluation / methods*
  • Quality Indicators, Health Care
  • United States