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Since physicians’ behaviour determines up to 80% of total healthcare expenditures, training residents to deliver high-value, cost-conscious care is essential. Residents acknowledge the importance of high-value, cost-conscious care-delivery, yet perceive training to be insufficient. We designed an observational study to gain insight into how the workplace setting relates to residents’ high-value, cost-conscious care-delivery.

This ethnographic study builds on 175 hours of non-participant observations including informal interviews, 9 semi-structured interviews and document analysis.

Department of obstetrics and gynaecology in an academic hospital in the Netherlands. Population or sample: 21 gynaecology residents.

Iterative analysis process of fieldnotes, interview transcripts and documents, including open-coding, thematic analysis and axial analysis by a multidisciplinary research team.

Residents rarely consider health care costs, and knowledge regarding costs is often absent. Senior consultants guide residents while balancing benefits, risks and costs, with or without explicating their decision-making process. Identified learning opportunities are elaboration on questions raised concerning high-value, cost-conscious care, checking information about costs that are used in discussions about high-value, cost-conscious care, and having a more open and explicit discussion about high-value, cost-conscious care.

Our study emphasizes that the opportunities and potential to train residents to deliver high-value, cost-conscious care in the workplace are present. The challenge resides in capitalizing on …