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There is consensus among medical education leaders that trainees must learn the principles of cost consciousness and resource stewardship.1,2 However, during teaching rounds, residents and students can derive an ambivalent approach to value. Particularly in academic centers where resources seem limitless, attending physicians often suggest additional tests that expand exhaustive differential diagnoses. This builds on trainees’ gnawing fear of missing something to establish thoroughness as an unrestrained virtue. The pressures of individualized quality metrics along with compressed inpatient evaluations to minimize length of stay may further reinforce this mindset and encourage defensive testing. These practices contradict and displace discussions of value.
Stern RJ, Parks AL. Teaching High-Value Care on RoundsModeling Moderation. JAMA Intern Med. 2016;176(2):262-263. doi:10.1001/jamainternmed.2015.6982