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Moriates C, Silverstein WK, Bandeira de Mello R, Stammen L, Wong BM. High-value care education can learn from the evidence-based medicine movement: moving beyond competencies and curricula to culture. BMJ Evid Based Med 2024; 29:147-150. [PMID: 37479241 DOI: 10.1136/bmjebm-2023-112270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Christopher Moriates
- Departments of Internal Medicine and Medical Education, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
- Executive Director, Costs of Care, Boston, Massachusetts, USA
| | - William K Silverstein
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Choosing Wisely Canada, Toronto, ON, Canada
| | - Renato Bandeira de Mello
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porte Alegre, Brazil
| | - Lorette Stammen
- School of Health Professions Education, Maastricht University, Maastricht, Limburg, Netherlands
| | - Brian M Wong
- Department of Medicine and Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
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Kroon D, van Dulmen SA, Westert GP, Jeurissen PPT, Kool RB. Development of the SPREAD framework to support the scaling of de-implementation strategies: a mixed-methods study. BMJ Open 2022; 12:e062902. [PMID: 36343997 PMCID: PMC9644331 DOI: 10.1136/bmjopen-2022-062902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE We aimed to increase the understanding of the scaling of de-implementation strategies by identifying the determinants of the process and developing a determinant framework. DESIGN AND METHODS This study has a mixed-methods design. First, we performed an integrative review to build a literature-based framework describing the determinants of the scaling of healthcare innovations and interventions. PubMed and EMBASE were searched for relevant studies from 1995 to December 2020. We systematically extracted the determinants of the scaling of interventions and developed a literature-based framework. Subsequently, this framework was discussed in four focus groups with national and international de-implementation experts. The literature-based framework was complemented by the findings of the focus group meetings and adapted for the scaling of de-implementation strategies. RESULTS The literature search resulted in 42 articles that discussed the determinants of the scaling of innovations and interventions. No articles described determinants specifically for de-implementation strategies. During the focus groups, all participants agreed on the relevance of the extracted determinants for the scaling of de-implementation strategies. The experts emphasised that while the determinants are relevant for various countries, the implications differ due to different contexts, cultures and histories. The analyses of the focus groups resulted in additional topics and determinants, namely, medical training, professional networks, interests of stakeholders, clinical guidelines and patients' perspectives. The results of the focus group meetings were combined with the literature framework, which together formed the supporting the scaling of de-implementation strategies (SPREAD) framework. The SPREAD framework includes determinants from four domains: (1) scaling plan, (2) external context, (3) de-implementation strategy and (4) adopters. CONCLUSIONS The SPREAD framework describes the determinants of the scaling of de-implementation strategies. These determinants are potential targets for various parties to facilitate the scaling of de-implementation strategies. Future research should validate these determinants of the scaling of de-implementation strategies.
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Affiliation(s)
| | | | | | | | - Rudolf B Kool
- IQ Healthcare, Radboudumc, Nijmegen, The Netherlands
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Ramsay D, Bolous Y, Huo B, McDermott EE, Campbell SG. The Effectiveness of an Interprofessional Education Course in Teaching the Importance of Choosing Wisely and Resource Stewardship: A Pilot Study. Cureus 2021; 13:e14850. [PMID: 34104594 PMCID: PMC8176570 DOI: 10.7759/cureus.14850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives Rising health care costs and an increase in unnecessary testing have sparked interest in resource stewardship (RS) and subsequently the Choosing Wisely Canada (CWC) campaign. Currently, all Canadian medical schools have student representatives for CWC; however, the same is not true in other health professions. Interprofessional care learned through interprofessional education (IPE) can lead to better patient outcomes. This study assessed whether an IPE course for health profession students was effective in teaching undergraduate students both interprofessional competencies and CWC principles. Methods An approximately seven-hour-long, four-session course was administered to Dalhousie University health profession students (N= 30). A validated survey for IPE competencies and a general survey about CWC principles were administered to assess the course. Descriptive statistics were used to assess the general CWC views, and paired samples t-tests were employed to compare pre- and post-IPE competencies. Results The full survey was completed by 25 (83%) students. Of these, 52% were female, within five health disciplines, and 13 (52%) had heard of CWC prior. Overall, the students agreed that CWC was important and relevant to their profession. They also reported significant improvements in multiple IPE competencies, including communication, collaboration, roles and responsibilities, patient-/family-centered care, conflict management/resolution, and team function. Conclusion Participants in our pilot Choosing Wisely IPE course valued the importance of the CWC campaign and reported improvement in multiple IPE competencies. This adaptable, simple, and low-cost course may be an effective way to integrate RS teaching across multiple health professions.
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Affiliation(s)
| | | | - Bright Huo
- Medicine, Dalhousie University, Halifax, CAN
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Aks R, Peleg Hasson S, Sivan A, Kohen T, Rivo L, Yerushalmi R, Kaufman B, Sonnenblick A, Wolf I. Diagnostic workup of early-stage breast cancer: can we choose more wisely? Breast Cancer Res Treat 2020; 183:741-748. [PMID: 32728861 DOI: 10.1007/s10549-020-05813-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Current international guidelines, including the Choosing Wisely Initiative, recommends against the routine use of systemic imaging studies or tumor markers in early-stage breast cancer. Accumulating data suggests that adherence to these guidelines is low. We aimed to investigate the execution of unnecessary diagnostic tests among Israeli breast cancer patients and identify factors associated with their performance. METHODS A retrospective analysis was conducted involving a database of early breast cancer patients treated at Tel Aviv Sourasky Medical Center. A survey was distributed among Israeli surgeons and oncologists specializing in breast cancer treatment. RESULTS The study included early breast cancer patients (n = 178), who have no indication for completing systemic evaluation. Nearly half of the patients (76, 42%) were referred to 128 unjustified diagnostic studies, with the most common referral comprising a PET-CT (n = 39 30.5%). As expected, none of the tests led to any change in either disease staging or alteration in clinical management. Variables associated with systemic evaluation included younger age (61.8% for < 50 years vs 38.9% for > 50 years, p = 0.02), diagnosis by palpable mass compared to screening mammography (26.9% vs 52.9% p = 0.043, respectively) and higher tumor grade (33.7% vs 52.2% p = 0.02, respectively). In concordance with the findings of the database, the physicians' survey revealed low adherence to guidelines and a role of the treating physicians' subjective feelings. Doctors were more likely to recommend unnecessary studies when presented with a clinical case as an image, than to an informative question. CONCLUSIONS Our data indicate a high rate of non-adherence to guidelines, physicians recommending extensive systemic evaluation for women with early breast cancer. These deviations from the guidelines are associated with subjective factors, some of them being physician-dependent. Initiatives aimed at improving adherence to guidelines, and specifically to guidelines recommending "doing less" should therefore include not just knowledge-based education but also encourage conversation about what is appropriate and necessary.
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Affiliation(s)
- Rona Aks
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shira Peleg Hasson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Ayelet Sivan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Kohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Larisa Rivo
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Oncology Institute, Assuta Ashdod, Israel
| | - Rinat Yerushalmi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Oncology, Davidoff Cancer Center, Belinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Bella Kaufman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Breast Oncology Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Amir Sonnenblick
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Wolf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Roth CG, Huang W, Sekhon N, Caruso A, Kung D, Greely J, Purkiss J, Ismail N. Teaching Laboratory Stewardship in the Medical Student Core Clerkships Pathology-Teaches. Arch Pathol Lab Med 2020; 144:883-887. [PMID: 31825668 DOI: 10.5858/arpa.2019-0329-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Current health care spending is unsustainable, and there is a need to teach high-value care principles to future physicians. Pathology-Teaches is an educational intervention designed to teach laboratory stewardship early in clinical training, at the level of the medical student in their core clinical clerkships. OBJECTIVE.— To assess the pilot implementation of case-based educational modules in 5 required core clerkships at our institution. DESIGN.— The online cases were developed by using a multidisciplinary approach. In the Pathology-Teaches educational module, students make decisions regarding the ordering or interpretation of laboratory testing within the context of a clinical scenario and receive immediate feedback during the case. The intervention was assessed by using pretest and posttest. Student feedback was also collected from end-of-rotation evaluations. RESULTS.— A total of 203 students completed the Pathology-Teaches pilot, including 72 in Family Medicine, 72 in Emergency Medicine, 24 in Internal Medicine, 24 in Neurology, and 11 in Obstetrics-Gynecology (OB-GYN). Pathology-Teaches utility was demonstrated by significantly increased improvement between pretest and posttest scores (mean, 63.1% versus 83.5%; P < .001; Hedge g effect size = 0.93). Of the 494 students who completed the Pathology-Teaches questions on the end-of-rotation evaluation, 251 provided specific feedback, with 38.6% (97 of 251) rating the activity as "extremely valuable" or "very valuable," and 41.4% (104 of 251) as "some/moderate value." Qualitative feedback included 17 positive comments with 6 requests to scale up or include more cases, 16 constructive comments for improvement mainly regarding the technical aspects, and 5 negative comments. CONCLUSIONS.— Pathology-Teaches effectively teaches stewardship concepts, and most students perceived value in this educational intervention.
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Affiliation(s)
- Christine G Roth
- From the Departments of Pathology & Immunology (Dr Roth), Family Medicine (Dr Huang), Internal Medicine (Drs Caruso, Purkiss, and Ismail), Emergency Medicine (Dr Sekhon), Neurology (Dr Kung), OB-GYN, (Dr Greely), and the Office of the Curriculum (Drs Purkiss and Ismail), Baylor College of Medicine, Houston, Texas
| | - William Huang
- From the Departments of Pathology & Immunology (Dr Roth), Family Medicine (Dr Huang), Internal Medicine (Drs Caruso, Purkiss, and Ismail), Emergency Medicine (Dr Sekhon), Neurology (Dr Kung), OB-GYN, (Dr Greely), and the Office of the Curriculum (Drs Purkiss and Ismail), Baylor College of Medicine, Houston, Texas
| | - Navdeep Sekhon
- From the Departments of Pathology & Immunology (Dr Roth), Family Medicine (Dr Huang), Internal Medicine (Drs Caruso, Purkiss, and Ismail), Emergency Medicine (Dr Sekhon), Neurology (Dr Kung), OB-GYN, (Dr Greely), and the Office of the Curriculum (Drs Purkiss and Ismail), Baylor College of Medicine, Houston, Texas
| | - Andrew Caruso
- From the Departments of Pathology & Immunology (Dr Roth), Family Medicine (Dr Huang), Internal Medicine (Drs Caruso, Purkiss, and Ismail), Emergency Medicine (Dr Sekhon), Neurology (Dr Kung), OB-GYN, (Dr Greely), and the Office of the Curriculum (Drs Purkiss and Ismail), Baylor College of Medicine, Houston, Texas
| | - Doris Kung
- From the Departments of Pathology & Immunology (Dr Roth), Family Medicine (Dr Huang), Internal Medicine (Drs Caruso, Purkiss, and Ismail), Emergency Medicine (Dr Sekhon), Neurology (Dr Kung), OB-GYN, (Dr Greely), and the Office of the Curriculum (Drs Purkiss and Ismail), Baylor College of Medicine, Houston, Texas
| | - Jocelyn Greely
- From the Departments of Pathology & Immunology (Dr Roth), Family Medicine (Dr Huang), Internal Medicine (Drs Caruso, Purkiss, and Ismail), Emergency Medicine (Dr Sekhon), Neurology (Dr Kung), OB-GYN, (Dr Greely), and the Office of the Curriculum (Drs Purkiss and Ismail), Baylor College of Medicine, Houston, Texas
| | - Joel Purkiss
- From the Departments of Pathology & Immunology (Dr Roth), Family Medicine (Dr Huang), Internal Medicine (Drs Caruso, Purkiss, and Ismail), Emergency Medicine (Dr Sekhon), Neurology (Dr Kung), OB-GYN, (Dr Greely), and the Office of the Curriculum (Drs Purkiss and Ismail), Baylor College of Medicine, Houston, Texas
| | - Nadia Ismail
- From the Departments of Pathology & Immunology (Dr Roth), Family Medicine (Dr Huang), Internal Medicine (Drs Caruso, Purkiss, and Ismail), Emergency Medicine (Dr Sekhon), Neurology (Dr Kung), OB-GYN, (Dr Greely), and the Office of the Curriculum (Drs Purkiss and Ismail), Baylor College of Medicine, Houston, Texas
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CJEM Debate Series: #ChoosingWisely - The Choosing Wisely campaign will not impact physician behaviour and choices. CAN J EMERG MED 2020. [PMID: 29534784 DOI: 10.1017/cem.2017.402] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Roth CG, Huang WY, Caruso AC, Sekhon N, Kung DH, Greely JT, Du YB, Holder-Haynes JG, Little JE, Fielder EK, Ismail NJ. How to Teach Laboratory Stewardship in the Undergraduate Medical Curriculum? Am J Clin Pathol 2020; 153:66-73. [PMID: 31836880 DOI: 10.1093/ajcp/aqz102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Promotion of high-quality care at a lower cost requires educational initiatives across the continuum of medical education. A needs assessment was performed to inform the design of an educational tool with the goal of teaching laboratory stewardship to medical students. METHODS The needs assessment consisted of semistructured interviews with core clerkship directors and residency program directors at our institution, a national survey to the Undergraduate Medical Educators Section (UMEDS) of the Association of Pathology Chairs, and a review of existing online resources that teach high-value care. RESULTS Two major themes emerged regarding opportunities to enhance laboratory stewardship education: appropriate ordering (knowledge of test indications, pretest/posttest probability, appropriateness criteria, recognition of unnecessary testing) and correct interpretation (understanding test specifications, factors that affect the test result, recognizing inaccurate results). CONCLUSIONS The online educational tool will focus on the curricular needs identified, using a multidisciplinary approach for development and implementation.
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Affiliation(s)
- Christine G Roth
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX
| | - William Y Huang
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - Andrew C Caruso
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX
| | - Navdeep Sekhon
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX
| | - Doris H Kung
- Department of Neurology, Baylor College of Medicine, Houston, TX
| | - Jocelyn T Greely
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Ye B Du
- Department of Psychiatry, Baylor College of Medicine, Houston, TX
| | | | - Jenelle E Little
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Elaine K Fielder
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Nadia J Ismail
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX
- Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, TX
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Born KB, Moriates C, Valencia V, Kerssens M, Wong BM. Learners as Leaders: A Global Groundswell of Students Leading Choosing Wisely Initiatives in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1699-1703. [PMID: 31299673 DOI: 10.1097/acm.0000000000002868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Resource stewardship and reducing low-value care have emerged as urgent priorities for health care delivery systems worldwide. However, few medical schools' curricula include adequate content to allow learners to master the knowledge, skills, and attitudes needed to contribute to this transformation toward value-based health care. This article describes a program to launch student-led curriculum enhancement initiatives in 7 countries. The program, called STARS (Students and Trainees Advocating for Resource Stewardship), was inspired by Choosing Wisely, a campaign by the American Board of Internal Medicine Foundation that seeks to promote conversations on avoiding unnecessary medical tests, treatments, and procedures.The initial STARS model, which originated in Canada in 2015, included a leadership summit, where students from multiple medical schools learned about Choosing Wisely principles, leadership, and advocacy. These students then led grassroots efforts at their local medical schools with faculty and other students to raise awareness and advocate for changes related to resource stewardship. Student-led efforts resulted in the integration of Choosing Wisely principles into case-based learning, the creation of student interest groups and electives, the launch of social media campaigns, and the organization of special presentations by local experts.The rapid spread of similar programs in 6 other countries (Italy, Japan, the Netherlands, New Zealand, Norway, and the United States) by 2018 suggests that STARS resonates across multiple settings and signals the potential for such a model to advance other important areas in medical education. This article documents results and lessons learned from the first 4 years of the program.
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Affiliation(s)
- Karen B Born
- K.B. Born is knowledge translation lead, Choosing Wisely Canada, and assistant professor, Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. C. Moriates is assistant dean for health care value, Department of Medical Education, and associate chair for quality, safety, and value and associate professor of internal medicine, Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas, and executive director, Costs of Care, Boston, Massachusetts. V. Valencia is assistant professor, Department of Medical Education, Dell Medical School, University of Texas at Austin, Austin, Texas. M. Kerssens is junior consultant at Adviestalent, part of Twynstra Gudde, Amersfoort, the Netherlands, and was recently a summer research intern with Choosing Wisely Canada, Toronto, Ontario, Canada. B.M. Wong is medical education lead, Choosing Wisely Canada, associate director, Centre for Quality Improvement and Patient Safety, University of Toronto, and associate professor, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Leep Hunderfund AN, Starr SR, Dyrbye LN, Baxley EG, Gonzalo JD, Miller BM, George P, Morgan HK, Allen BL, Hoffman A, Fancher TL, Mandrekar J, Reed DA. Imprinting on Clinical Rotations: Multisite Survey of High- and Low-Value Medical Student Behaviors and Relationship with Healthcare Intensity. J Gen Intern Med 2019; 34:1131-1138. [PMID: 30756307 PMCID: PMC6614293 DOI: 10.1007/s11606-019-04828-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 10/25/2018] [Accepted: 12/18/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Physician behaviors are important to high-value care, and the learning environment medical students encounter on clinical clerkships may imprint their developing practice patterns. OBJECTIVES To explore potential imprinting on clinical rotations by (a) describing high- and low-value behaviors among medical students and (b) examining relationships with regional healthcare intensity (HCI). DESIGN Multisite cross-sectional survey PARTICIPANTS: Third- and fourth-year students at nine US medical schools MAIN MEASURES: Survey items measured high-value (n = 10) and low-value (n = 9) student behaviors. Regional HCI was measured using Dartmouth Atlas End-of-Life Chronic Illness Care data (ratio of physician visits per decedent compared with the US average, hospital care intensity index, ratio of medical specialty to primary care physician visits per decedent). Associations between regional HCI and student behaviors were examined using unadjusted and adjusted (controlling for age, sex, and year in school) logistic regression analyses, using median item ratings to summarize reported engagement in high- and low-value behaviors. KEY RESULTS Of 2623 students invited, 1304 (50%) responded. Many reported trying to determine healthcare costs (1085/1234, 88%), but only 45% (571/1257) reported including cost details in case presentations. Students acknowledged suggesting tests solely to anticipate what their supervisor would want (1143/1220, 94%), show off their ability to generate a broad differential diagnosis (1072/1218, 88%), satisfy curiosity (958/1217, 79%), protect the team from liability (938/1215, 77%), and build clinical experience (533/1217, 44%). Students in higher intensity regions reported significantly more low-value behaviors: each one-unit increase in the ratio of physician visits per decedent increased the odds of reporting low-value behaviors by 20% (OR 1.20, 95% CI 1.04-1.38; P = 0.01). CONCLUSIONS Third- and fourth-year medical students report engaging in both high- and low-value behaviors, which are related to regional HCI. This underscores the importance of the clinical learning environment and suggests imprinting is already underway during medical school.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Bradley L Allen
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ari Hoffman
- University of California, San Francisco, San Francisco, CA, USA
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Rodrigues Mendonça D, Aguiar CVN, Lins-Kusterer L, de Oliveira RI, Menezes MS. Choosing Wisely in Pediatric Internship. Glob Pediatr Health 2019; 6:2333794X19848869. [PMID: 31205983 PMCID: PMC6537288 DOI: 10.1177/2333794x19848869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/31/2019] [Accepted: 04/05/2019] [Indexed: 12/19/2022] Open
Abstract
Background. The Choosing Wisely (CW) campaign informs physicians
and the public about safety and quality in medical practice.
Objective. To evaluate a CW campaign in a medical
internship in pediatrics. Methods. An interventionist study
with teachers of medicine and pediatric internship students in which the Delphi
technique was applied using online questionnaires. Specialists identified 3
unnecessary situations that commonly occur in clinical practice. Following the
Objective Structured Clinical Examination (OSCE) model evaluation, a group of
students who participated in the educational interventions was compared with
another group that was not exposed to the campaign. Results.
Most students evaluated the CW campaign content as excellent (64%) or very good
(31.6%). The level of successes in the OSCE evaluation was higher in the exposed
group when compared with the nonexposed group (P = .001).
Conclusions. The CW campaign improved the clinical skills
of pediatric internship students.
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Thistlethwaite JE. Questions and answers in health care and education. EDUCATION FOR PRIMARY CARE 2018; 29:3-4. [DOI: 10.1080/14739879.2017.1377052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cardone F, Cheung D, Han A, Born KB, Alexander L, Levinson W, Wong BM. Choosing Wisely Canada Students and Trainees Advocating for Resource Stewardship (STARS) campaign: a descriptive evaluation. CMAJ Open 2017; 5:E864-E871. [PMID: 29263153 PMCID: PMC5741424 DOI: 10.9778/cmajo.20170090] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Resource stewardship is being increasingly recognized as an essential competency for physicians, but medical schools are just beginning to integrate this into education. We describe the evaluation of Choosing Wisely Canada's Students and Trainees Advocating for Resource Stewardship (STARS) campaign, a student-led campaign to advance resource stewardship education in medical schools across Canada. METHODS We evaluated the campaign 6 months after its launch, in November 2015. STARS students were administered a telephone survey eliciting a description of the initiatives that they had implemented or planned to implement at their schools to promote resource stewardship, and exploring their perceptions of facilitators of and barriers to successful implementation of their initiatives. We used a mixed-methods approach to analyze and summarize the data. RESULTS Twenty-seven (82%) of the 33 eligible students representing all 17 medical schools responded. In 14 schools (82%), students led various local activities (e.g., interest groups, campaign weeks) to raise awareness about resource stewardship among medical students and faculty. Students contributed to curriculum change (both planned and implemented) at 10 schools (59%). Thematic analysis revealed key program characteristics that facilitated success (e.g., pan-Canadian student network, local faculty champion) as well as barriers to implementing change (e.g., complex processes to change curriculum, hierarchical nature of medical school). INTERPRETATION This student-led campaign, with support from local faculty and Choosing Wisely Canada staff, led to awareness-building activities and early curricula change at medical schools across Canada. Future plans will build on the initial momentum created by the STARS campaign to sustain and spread local initiatives.
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Affiliation(s)
- Franco Cardone
- Affiliations: Faculty of Medicine (Cardone, Cheung, Han, Alexander), University of Toronto; Choosing Wisely Canada (Born, Levinson, Wong), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Born); Department of Medicine (Levinson, Wong); Centre for Quality Improvement and Patient Safety (Wong), University of Toronto, Toronto, Ont
| | - Daphne Cheung
- Affiliations: Faculty of Medicine (Cardone, Cheung, Han, Alexander), University of Toronto; Choosing Wisely Canada (Born, Levinson, Wong), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Born); Department of Medicine (Levinson, Wong); Centre for Quality Improvement and Patient Safety (Wong), University of Toronto, Toronto, Ont
| | - Angela Han
- Affiliations: Faculty of Medicine (Cardone, Cheung, Han, Alexander), University of Toronto; Choosing Wisely Canada (Born, Levinson, Wong), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Born); Department of Medicine (Levinson, Wong); Centre for Quality Improvement and Patient Safety (Wong), University of Toronto, Toronto, Ont
| | - Karen B Born
- Affiliations: Faculty of Medicine (Cardone, Cheung, Han, Alexander), University of Toronto; Choosing Wisely Canada (Born, Levinson, Wong), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Born); Department of Medicine (Levinson, Wong); Centre for Quality Improvement and Patient Safety (Wong), University of Toronto, Toronto, Ont
| | - Lisa Alexander
- Affiliations: Faculty of Medicine (Cardone, Cheung, Han, Alexander), University of Toronto; Choosing Wisely Canada (Born, Levinson, Wong), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Born); Department of Medicine (Levinson, Wong); Centre for Quality Improvement and Patient Safety (Wong), University of Toronto, Toronto, Ont
| | - Wendy Levinson
- Affiliations: Faculty of Medicine (Cardone, Cheung, Han, Alexander), University of Toronto; Choosing Wisely Canada (Born, Levinson, Wong), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Born); Department of Medicine (Levinson, Wong); Centre for Quality Improvement and Patient Safety (Wong), University of Toronto, Toronto, Ont
| | - Brian M Wong
- Affiliations: Faculty of Medicine (Cardone, Cheung, Han, Alexander), University of Toronto; Choosing Wisely Canada (Born, Levinson, Wong), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Born); Department of Medicine (Levinson, Wong); Centre for Quality Improvement and Patient Safety (Wong), University of Toronto, Toronto, Ont
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Lee IT, Di Capua J, Cho HJ. Considering Cocreation for the Choosing Wisely List. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:576. [PMID: 28441197 DOI: 10.1097/acm.0000000000001644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Irene Timothy Lee
- Medical student, Icahn School of Medicine at Mount Sinai, New York, New York; . Medical student, Icahn School of Medicine at Mount Sinai, New York, New York. Director of quality and patient safety and assistant professor of medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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