"Challenges in high-value cost-conscious care training of residents: Exploring the various stakeholders’ roles and attitudes" 

Keywords: Residency training, High value, cost conscious care (HVCCC), Learning environment, Co-creation

This thesis aimed to understand how the workplace can best support residents in their learning to provide HVCCC. We found that the workplace of residents during their education is shaped by faculty, peers and patients. Our results provide several insights. First, the multiple stakeholders that are present in the workplace hold a variety of attitudes toward HVCCC, with faculty and administrators having the most positive, and patients having the most negative. Second, for a better learning environment, it is recommended for faculty and teachers to collaborate with residents on the design of their education. Third, a safe learning environment for residents to learn and work in, facilitates both (1) the support for residents to deal with the HVCCC attitudes of others, as they dare to question and challenge them, and (2) the collaboration with faculty and teachers, as they feel encouraged to speak up and share thoughts and ideas. If residents are trained to provide HVCCC, they can be educated into true HVCCC professionals who are able to adequately balance quality and costs of medical interventions and practices and thereby contribute to the sustainability of healthcare.