Thomas L. Schwenk, MD reviewing Stammen LA et al. JAMA 2015 Dec 8. Korenstein D. JAMA 2015 Dec 8.

Part of the approach to improving delivery of high-value medical care is physician education. In this systematic review, researchers identified 79 studies in which interventions to train physicians to provide high-quality, cost-conscious care were evaluated; 62 studies were from North America, 14 were randomized trials, and 46 were pre–post-interventional studies. About 60% of studies focused on practicing physicians or other healthcare professionals, and 21% targeted resident physicians or medical students.

In 87% of studies, the interventions improved delivery of appropriate, cost-effective care. Data analysis revealed that three factors influenced the success of these interventions: (1) knowledge transmission, (2) reflective practice, and (3) a supportive environment. Knowledge transmission focused on raising awareness of the prices of medical services, general principles of healthcare economics, scientific evidence (e.g., evidence-based guidelines), and patient preferences. Reflective practice included providing feedback to physicians about their performance (their own or compared with that of colleagues), facilitating discussions with experts and supervisors, and use of electronic reminders and alerts. A supportive environment included the presence of knowledgeable clinical role models and teachers and creation of a value system among physicians, nurses, and other healthcare professionals that encouraged cost-conscious, high-value care.


These results help delineate the educational features that lead to improved delivery of high-value care. The authors note, and I agree, that most studies are somewhat lacking in rigorous design, which is especially unfortunate given the importance of educating physicians to provide high-quality care while lowering costs.


Stammen LA et al. Training physicians to provide high­value, cost­conscious care: A systematic review. JAMA 2015 Dec 8; 314:2384. (

Korenstein D.Charting the route to high­value care: The role of medical education. JAMA 2015 Dec 8; 314:2359. (