A student-led interactive campaign day teaching UME trainees to Choose Wisely
Author: Sudarshan J Mohan, Bachelor of Science in Public Health in Biostatistics and Quantitative Biology (UNC‐Chapel Hill), Master of Science in Biomedical Sciences (EVMS), Medical Student (second year), School of Medicine, EVMS, Eastern Virginia Medical School, Norfolk, Virginia
Co-Authors: Lauren Keenan/B.S. Cell Biology and Biochemistry, Bucknell Univ. (2017), Medical Student, Eastern Virginia Medical School/Norfolk, VA
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.