Exemplary Quotes of Themes and Subthemes Identified in Resident Focus Groups

Curriculum contribution to understanding of HVC
 How an intervention changes management
  Overall“[P]rompting us to think about why we’re ordering tests and if they’re really providing value is the main thing that this has done.” CCHMC2.2
  Benefit to the patient“I think it has made me more mindful of why am I ordering this test? What benefit is it really going to be to the patient?” CHOP1.1
“One thing that I appreciate about value in general is it forces you to say why am I doing this, and at least forecast a little bit how might this help, how might this hurt, how might this do nothing, and what do I think those are?” CHOP1.2
  Safely doing less“We’d go through all the orders and see how frequently are they getting the labs, and then we would sort of decide do we need them that frequently? And normally…we would decrease the frequency of them, so I feel there was a conscious [effort] to decrease unnecessary labs and/or only get the parts that you needed.” CCHMC1.1
  Right test for the right patient“It’s like did I order 8 things, and did they only need me to order 2 or 3? And then I think in particular, imaging tends to be more expensive. So, what image did they need, and did I need to get it tonight, or could it wait for a little bit more of a discussion on rounds as to what the right image is?” CHOP1.2
 Prompted discussion“[T]he value of the curriculum is just starting the conversation or making it something to think about or be aware of, because I think there’s so many nuances…cost, medications, and things like that. So, just helping us know some of those things and setting that conversation.” CCHMC3.2
 Thinking about the cost as a harm“The thing that’s probably hit me the hardest is not only the cost but then the charge to the patients.” CCHMC1.2
“It’s more money than I could afford, so I can’t imagine what it’s like for most of our patients…we’re supposed to be advocates for our patients, and I don’t even know what the actual impact of my actions are all the time, so I think that’s a huge value of talking about the cost of things. It empowers me to be better at my job.” CCHMC2.2
How HVC affects practice
 Better understanding of medicine“So, I think not only in just the abstract…we need to reduce our costs in general and provide better quality care, etc, but I actually think it forces you to think about disease processes and learn medicine a little bit too, because that informs how valuable you think the test is. So, I think it does force you to think about things and learn both medicine and also like, health economics or whatever you want to call it, a little bit better.” CHOP1.2
 Better understanding of health care system“I also think that healthcare costs are ridiculous and…ridiculously expensive, but I don’t know enough details about it to advocate…. And so I think that the benefit comes also in helping us be better advocates for making our health system better.” CCHMC2.1
 Changed how I ordered…“And I found myself ordering less and different kinds of lab tests on a lot of patients that before the curriculum I would have practiced differently. But knowing certain aspects of the curriculum and…how I could become more aware and become a better high-value practitioner changed how I ordered a lot of labs and imagining.” CCHMC1.2
“And so I would say most of the patients on our team, even if they were on IV fluids, we didn’t get renals unless we were concerned that maybe they had some lactoid abnormality or unless they were on fluids like a week…I think we were a lot more thoughtful about that. And I think that’s a big part to this curriculum, people sort of forcing us to think about what benefit does…the lab have?” CCHMC1.3
“I think the biggest, where I’ve done it myself, is transitioning people to PO medications fastest and like avoiding IV Tylenol…. And then the benefit also trying to transition them too, if they tolerate their 1 dose of oral antibiotics and then getting them out the door a little bit faster.” CCHMC3.1
 Hone your clinical skills“I think it makes you hone in on your clinical skills in terms of really trying to hone in on one or a few diagnoses and then relying more on your physical exam skills, your history taking, and then sort of your clinical reasoning.” CCHMC1.2
“But also I think it forces us to be better clinicians, because it forces us to think about what we’re doing and why we’re doing it, what information it’s going to give us, and whether or not it’s actually going to give us any information that we would act on.” CCHMC2.1
  • IV, intravenous; PO, by mouth. In this table, individual participants are denoted by first location where the focus group took place (CHOP or CCHMC), then by the number of the focus group held their, and lastly by the number assigned to each participant.