Residents’ Reflections on Cost-Conscious Care after International Health Electives: A Single-Center Qualitative Study

Caroline L. Matchett, Hannah C. Nordhues, M. Usmaan Bashir, Stephen P. Merry, Adam P. Sawatsky

Research output: Contribution to journalArticlepeer-review


Background: Estimates suggest 30% of health care expenditures are wasteful. This has led to increased educational interventions in graduate medical education (GME) training aimed to prepare residents for high value, cost-conscious practice. International health electives (IHE) are widely available in GME training and may be provide trainees a unique perspective on principles related to high value, cost-conscious care (HVCCC). Objective: The purpose of this study was to explore how trainee reflections on IHE experiences offer insight into HVCCC. Design: The authors conducted an applied thematic analysis of narrative reflective reports of GME trainees’ IHE experiences to characterize their perceptions of HVCCC. Participants: The Mayo International Health Program (MIHP) supports residents and fellows from all specialties across all Mayo Clinic sites. We included 546 MIHP participants from 2001 to 2020. Approach: The authors collected post-elective narrative reports from all MIHP participants. Reflections were coded and themes were organized into model for transformative learning during IHEs, focusing on HVCCC. Key Results: GME trainees across 24 different medical specialties participated in IHEs in 73 different countries. Three components of transformative learning were identified: disorienting dilemma, critical reflection, and commitment to behavior change. Within the component of critical reflection, three topics related to HVCCC were identified: cost transparency, resource stewardship, and reduced fear of litigation. Transformation was demonstrated through reflection on future behavioral change, including cost-aware practice, stepwise approach to health care, and greater reliance on clinical skills. Conclusions: IHEs provide rich experiences for transformative learning and reflection on HVCCC. These experiences may help shape trainees’ ideology of and commitment to HVCCC practices.

Original languageEnglish (US)
Pages (from-to)42-48
Number of pages7
JournalJournal of general internal medicine
Issue number1
StatePublished - Jan 2023


  • International health electives
  • cost conscious care
  • high value care

ASJC Scopus subject areas

  • Internal Medicine


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