Background: The negative implications of wasteful healthcare spending are well‐documented in literature; yet, the  physician’s responsibility in reducing healthcare costs is not effectively taught during medical training.  Recently, many have advocated for the addition of a high‐value care (HVC) competency to modern  medical curriculum in an effort to pre‐emptively educate students on resource stewardship and  counteract high‐ordering practice habits often developed in residency. Eastern Virginia Medical  School has taken steps to establish a high‐value care thread within our Care Forward Curriculum. The  inaugural year (2018‐2019) of incorporating Choosing Wisely into the curriculum included an  interactive learning day for the entire community that is described here.

Intervention: The inaugural Choosing Wisely Day took place on November 16, 2018. The event was open to  students of all‐disciplines and levels, residents, attendings, and faculty. Events included a keynote  with a well‐known high‐value care expert, a poster session with “Top 5” Choosing Wisely  recommendations, and an innovation challenge, modeled after the popular television show Shark  Tank. We also hosted the American College of Radiology, who prepared several Choosing Wisely‐ based cases and taught students to use their Clinical Decision Support Tool to aid in providing high‐ value care.

Outcomes: Over 100 students representing each of our medical school classes and numerous faculty attended  and/or participated in at least one of the events during the day. The most notable outcome of the day  was establishing a value‐added role for students to engage residents, attendings, and other faculty by  using recommendations supported by medical specialty societies to advocate for patients. Following  the intervention, attendees were administered a pre‐/post‐evaluation, designed to survey students'  prior knowledge about high‐value care, willingness to seek out Choosing Wisely resources, and  comfort in applying HVC concepts in the clinical setting. Results indicated that students largely  recognized low‐value care as an issue at baseline, even though statistically significant increases  (p<.01) were observed in students' agreement with statements establishing the presence and ill effect  of low‐value care. A key finding was students' markedly increased reported likelihood to seek out  Choosing Wisely recommendations to guide their clinical decision making (p<.0001). This suggests  that Choosing Wisely Day may have provided students with the knowledge and resources to  incorporate value into their medical education and practice prior to entry into residency. However, we  also observed that students reported relatively low comfort levels in identifying overuse and advising  patients accordingly in the clinical setting. We thus have recognized skills involved in practicing high‐ value care as a target area for improving subsequent Choosing Wisely events.

Future Directions: We will continue to host a Choosing Wisely campaign day annually, while ensuring to modify event  content to address students’ self‐reported areas of weakness in applying HVC in clinical practice. In  future years, we will continue to engage students in both the planning and execution of the event, increase attendance through improved marketing, and further increase awareness of Choosing Wisely  and the importance of High‐Value Care.

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