The researchers contend that if “value” is considered the ratio of health benefits achieved per unit of cost, value can be increased in several ways. This could be accomplished by increasing health benefits, decreasing costs, or accepting less health benefit as a trade-off for cost savings. However, teaching approaches that overemphasize cost savings could risk causing trainees to lose sight of individual patient welfare or create unintended consequences for subsequent bedside decision-making.3

Co-author Matthew DeCamp, MD, PhD, assistant professor of medicine at the Johns Hopkins University School of Medicine in Baltimore, said physicians must sometimes balance ethical tension between cost saving and patient welfare. He noted the best way to do this has not been settled among ethics scholars and practicing physicians. This lack of consensus could lead to inexperienced medical trainees misunderstanding their duty.

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“From the standpoint of ethics, ensuring that the effects of medical training on professional identity formation are captured is key.  We sometimes think of evaluating ethics and professionalism as a separate domain from the rest of medical training,” said Dr DeCamp, who is also a faculty member at the Johns Hopkins Berman Institute of Bioethics. 

He explained that ethics and value have to be evaluated together. For example, with the growing popularity of high-value care education, it would be important to evaluate the impact of high value care education on not just costs and quality but also on how medical trainees understand their identity and ethical obligations as health professionals. 

“In the high-value care domain, there may be teachers with a keen understanding of value-based health care but less understanding of medical professionalism or vice versa,” Dr DeCamp told Endocrinology Advisor

However, he said this problem is not insurmountable, if educators are given the time and resources to design and evaluate curricula together rather than as separate units. He and his co-author contend that ambiguity regarding the primacy of patient welfare in high-value care education risks patient distrust and societal backlash.  


  1. Hauer KE,  Vandergrift J,  Hess B, et al. Correlations between ratings on the resident annual evaluation summary and the internal medicine milestones and association with ABIM certification examination scores among US internal medicine residents, 2013-2014. JAMA. 2016; 316(21):2253-2262. doi:10.1001/jama.2016.17357.
  2. Melvin L, Cavalcanti RB. The oral case presentation: A key tool for assessment and teaching in competency-based medical education. JAMA. 2016;316(21):2187-2188. doi:10.1001/jama.2016.16415.
  3. DeCamp M, Riggs KR. Navigating ethical tensions in high-value care education. JAMA. 2016; 316(21):2189-2190. doi:10.1001/jama.2016.17488.