ArticleJournal of general internal medicine2019
Imprinting on Clinical Rotations: Multisite Survey of High- and Low-Value Medical Student Behaviors and Relationship with Healthcare Intensity.
Article in Journal of general internal medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.
- Value-Based Healthcare From the Perspective of the Healthcare Professional: A Systematic Literature Review.Frontiers in public health · 2021Pooled it
- Medical Students' Observations of High-Value Care in Clinical Training: Progress Rather than Perfection.Journal of general internal medicine · 2025Article
- Medical Students' Observations of High Value and Potentially Wasteful Care Behaviors Modeled During Clinical Rotations.Journal of general internal medicine · 2025Article
- High-Value Care Education in the USA: Lessons from a National Value Curriculum for Resident and Fellow Physicians.Journal of general internal medicine · 2025Article
- Factors Associated with Medical Students' Attitudes About Cost-Conscious Care: A Mixed-Methods Multi-school Study.Journal of general internal medicine · 2025Article
- End-of-life cohorts from the Dartmouth Institute: risk adjustment across health care markets, the relative efficiency of chronic illness utilization, and patient experiences near the end of life.Research in health services & regions · 2024Review
- Clinical nursing mentors' motivation, attitude, and practice for mentoring and factors associated with them.BMC nursing · 2024Article
- Effect of a high value care curriculum on standardized patient exam in the Core Clerkship in Internal Medicine.BMC medical education · 2020Article
- Capsule Commentary on Hunderfund et al., Imprinting on Clinical Rotations: Multisite Survey of High- and Low-Value Medical Student Behaviors and Relationship with Healthcare Intensity.Journal of general internal medicine · 2019Article
Corrections and comments
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Authors and funding
13 authors at 9 institutions in 1 country.
Funding
Abstract
backgroundPhysician behaviors are important to high-value care, and the learning environment medical students encounter on clinical clerkships may imprint their developing practice patterns.
objectivesTo explore potential imprinting on clinical rotations by (a) describing high- and low-value behaviors among medical students and (b) examining relationships with regional healthcare intensity (HCI).
designMultisite cross-sectional survey
participantsThird- and fourth-year students at nine US medical schools MAIN MEASURES: Survey items measured high-value (n = 10) and low-value (n = 9) student behaviors. Regional HCI was measured using Dartmouth Atlas End-of-Life Chronic Illness Care data (ratio of physician visits per decedent compared with the US average, hospital care intensity index, ratio of medical specialty to primary care physician visits per decedent). Associations between regional HCI and student behaviors were examined using unadjusted and adjusted (controlling for age, sex, and year in school) logistic regression analyses, using median item ratings to summarize reported engagement in high- and low-value behaviors. KEY
resultsOf 2623 students invited, 1304 (50%) responded. Many reported trying to determine healthcare costs (1085/1234, 88%), but only 45% (571/1257) reported including cost details in case presentations. Students acknowledged suggesting tests solely to anticipate what their supervisor would want (1143/1220, 94%), show off their ability to generate a broad differential diagnosis (1072/1218, 88%), satisfy curiosity (958/1217, 79%), protect the team from liability (938/1215, 77%), and build clinical experience (533/1217, 44%). Students in higher intensity regions reported significantly more low-value behaviors: each one-unit increase in the ratio of physician visits per decedent increased the odds of reporting low-value behaviors by 20% (OR 1.20, 95% CI 1.04-1.38; P = 0.01).
conclusionsThird- and fourth-year medical students report engaging in both high- and low-value behaviors, which are related to regional HCI. This underscores the importance of the clinical learning environment and suggests imprinting is already underway during medical school.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.