Surveying First-Year Medical Students on Cost Knowledge and Attitudes Toward Cost-Conscious Care: Before and After Integration of Cost Awareness Curriculum

Introduction The US health care system imposes a heavy cost burden on Americans, contributing to high medical expenses and growing medical debt. Teaching medical trainees the importance of high-value care has been one strategy to combat this. The authors have introduced a cost awareness curriculum to first-year medical students and surveyed them on their knowledge and attitudes toward cost-conscious care before and after this intervention. Methods This repeated cross-sectional study used an anonymous, online pre-post-survey sent to first-year medical students in July and August of 2023 and 2024. Students were surveyed before and after out-of-pocket costs of commonly ordered items were displayed in preclinical lecture slides. Primary outcomes included changes in knowledge and attitude scores based on cost-estimate accuracy and agreement with cost-conscious statements. Pre-post groups were compared using χ 2 and Wilcoxon rank-sum tests. Results A total of 71 of 145 (49%) first-year medical students completed the presurvey, and 75 (51%) completed the postsurvey. On average, respondents correctly estimated the costs of 2 out of 9 commonly ordered items. There was high baseline support for cost-conscious care, and there was no difference in either attitudes or cost knowledge after exposure to the curriculum. Discussion First-year medical students supported cost-conscious care even without prior exposure to the concept. Despite ease of curriculum implementation, passive cost displays were insufficient to improve knowledge or change attitudes toward cost-conscious care. Conclusion Future studies could evaluate more substantial curricular changes such as case-based learning to assess whether they are more likely to impact cost awareness of medical trainees.