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Acad Med. 2018 May 22. doi: 10.1097/ACM.0000000000002299. [Epub ahead of print]

Value-Added Activities in Medical Education: A Multi-Site Survey of First- and Second-Year Medical Students' Perceptions and Factors Influencing Their Potential Engagement.

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A.N. Leep Hunderfund is assistant professor of neurology, Mayo Clinic, and associate director, Mayo Clinic Program in Professionalism and Values, Rochester, Minnesota. S.R. Starr is associate professor of pediatrics and director, Science of Health Care Delivery Education, Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota. L.N. Dyrbye is professor of medical education and medicine, Mayo Clinic, Rochester, Minnesota. J.D. Gonzalo is associate professor of medicine and public health sciences and associate dean, Health Systems Education, Pennsylvania State University College of Medicine, Hershey, Pennsylvania. P. George is associate professor of family medicine and associate professor of medical science, Alpert Medical School, Brown University, Providence, Rhode Island. B.M. Miller is professor of medical education and administration and professor of clinical surgery, associate vice chancellor, Health Affairs, and senior associate dean, Health Sciences Education, Vanderbilt University School of Medicine, Nashville, Tennessee. H.K. Morgan is associate clinic professor of obstetrics and gynecology and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan. A. Hoffman is assistant clinical professor of medicine, division of hospital medicine, University of California, San Francisco School of Medicine, San Francisco, California. E.G. Baxley is professor of family medicine and senior associate dean, Academic Affairs, Brody School of Medicine, East Carolina University, Greenville, North Carolina. B.L. Allen is associate professor of clinical medicine and senior associate dean, Medical Student Education, Indiana University School of Medicine, Indianapolis, Indiana. T.L. Fancher is associate professor of medicine, University of California Davis School of Medicine, Sacramento, California. J. Mandrekar is professor of biostatistics and neurology, Mayo Clinic, Rochester, Minnesota. S.E. Skochelak is group vice president for medical education, American Medical Association, Chicago, Illinois. D.A. Reed is associate professor of medical education and medicine and senior associate dean, Academic Affairs, Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota.



To describe attitudes of first- and second-year U.S. medical students toward value-added medical education, assess their self-reported desire to participate in various value-added activities, and identify potentially modifiable factors influencing their engagement.


The authors conducted a cross-sectional survey of first- and second-year students at nine U.S. medical schools in 2017. Survey items measured students' attitudes toward value-added medical education (n = 7), desire to participate in value-added activities (n = 20), and factors influencing potential engagement (n = 18).


Of 2,670 medical students invited to participate, 1,372 (51%) responded. Seventy-six percent (1,043/1,368) moderately or strongly agreed they should make meaningful contributions to patient care. Students' desire to participate was highest for patient care activities approximating those traditionally performed by physicians, followed by systems improvement activities and lowest for activities not typically performed by physicians. Factors increasing desire to participate included opportunities to interact with practicing physicians (1,182/1,244, 95%), patients (1,177/1,246, 95%), and residents or fellows (1,166/1,246, 94%). Factors decreasing desire to participate included making changes to the healthcare system (365/1,227, 30%), interacting with patients via phone or electronic communication (410/1,243, 33%), and lack of dedicated curricular time (634/1,233, 51%).


First- and second-year medical students agree they should add value to patient care, but their desire to participate in value-added activities varies depending on the nature of the tasks involved. Medical schools may be able to increase students' desire to participate by enabling face-to-face interactions with patients, embedding students in healthcare teams, and providing dedicated curricular time.

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