Choosing Wisely: Resource Stewardship in Canadian Medical Schools. Why do residents order unnecessary labs? Published in the March 2017 issue of Today’s Hospitalist ALL INPATIENTS should routinely have a daily CBC and basic chemistry screen, right?
Not so, according to the Society of Hospital Medicine, which has identified these often-unnecessary orders as part of the Choosing Wisely campaign. But despite that recommendation, many residents continue ordering such tests—even when they know those orders aren’t needed. This puzzling fact concerned the House Staff and Advanced Practice Provider Quality Council of Philadelphia’s Hospital of the University of Pennsylvania (HUP). Jennifer Myers, MD, a hospitalist who is the faculty advisor for that council, is also director of quality and safety education in the department of medicine at the Perelman School of Medicine. “Each year, our council leads quality improvement efforts,” Dr. Residents’ self-reported patterns To find out, the council distributed a 15-question survey to 116 internal medicine and general surgery residents at HUP.
Tracking Resident Orders to See If They’re Reducing Unnecessary Tests. Does showing residents the number of hospital tests they order in comparison to their peers encourage them to order more appropriately?
Physicians in the Department of Medicine will find out, thanks to a soon-to-be-launched dashboard that uses Epic data to track the number of tests residents order for patients. The dashboard focuses on residents because they manage most hospitalized Department of Medicine patients, but it could one day be broadened to include faculty members. “There’s no way to change behavior if you don’t know what your behavior is,” says Lenny Feldman, an internist who helped create the dashboard with fellow internist Amit Pahwa and the Johns Hopkins Technology Innovation Center.
The Buffy Care dashboard (named after Buffy the Vampire Slayer) focuses on tracking blood tests and imaging, like CT and MRI scans. Assessing Correlations of Physicians' Practice Intensity and Certainty During Residency Training. Spending patterns in region of residency training and subsequent expenditures for care provided by practicing physicians for Medicare beneficiaries. Role-Modeling Cost-Conscious Care—A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States. The Association Between Residency Training and Internists’ Ability to Practice Conservatively. Tolerating Uncertainty - The Next Medical Revolution? Choosing Wisely®: Things we do for no reason - Feldman - 2015 - Journal of Hospital Medicine. Test ordering by GP trainees. Physician Understanding and Ability to Communicate Harms and Benefits of Common Medical Treatments. From Choosing Wisely to Practicing Value—More to the Story.
All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Residents' self-report on why they order perceived unnecessary inpatient laboratory tests - Sedrak - 2016 - Journal of Hospital Medicine. Teaching high-value care: a novel morning report - Bowman - 2015 - The Clinical Teacher. Teaching high-value, cost-conscious care to residents: the Alliance for Academic Internal Medicine–American College of Physicians Curriculum.
Medicine’s Push for Resource Stewardship in Education and Practice. Scare: stewardship curriculum and audit for residents to cultivate efficiency. A New Model for Medical EducationCelebrating RestraintA New Model for Medical Education. Health care expenditures are a major concern of governments in Canada and the United States.
Over the past 40 years, a variety of approaches have been used to control costs, including global budgeting, managed competition, cost sharing, and pay for performance. Policy makers recognize that physicians play a central role, with some estimates suggesting that physicians control 80% of health expenditures.1 Most policy recommendations therefore acknowledge the importance of physicians in implementing changes to health care organization. Training Physicians to Provide High-Value, Cost-Conscious Care: A Systematic Review. Importance Increasing health care expenditures are taxing the sustainability of the health care system.
Physicians should be prepared to deliver high-value, cost-conscious care. Objective To understand the circumstances in which the delivery of high-value, cost-conscious care is learned, with a goal of informing development of effective educational interventions. Data Sources PubMed, EMBASE, ERIC, and Cochrane databases were searched from inception until September 5, 2015, to identify learners and cost-related topics. Study Selection Studies were included on the basis of topic relevance, implementation of intervention, evaluation of intervention, educational components in intervention, and appropriate target group. There was no restriction on study design. Teach trainees more thought, less waste. From the March ACP Hospitalist, copyright © 2015 by the American College of Physicians By Julie Knudson Teaching students and residents to practice high-value care requires a significant shift from traditional training methods.
“Historically, the culture has been that nobody was criticized for ordering more tests than necessary, but they did get criticized for leaving out a test that a supervising physician felt needed to be ordered,” said Jeff Wiese, MD, FACP, senior associate dean at Tulane University in New Orleans. Photo by Thinkstock Academic hospitalists have been developing strategies to teach trainees how to balance the benefits of a medical intervention with harms and costs, in keeping with general efforts in medicine to reduce waste and improve outcomes. Imprinting this skill, and whole outlook, on future doctors requires not only lectures and assessment but role models who provide care that optimizes outcomes without incurring unnecessary costs, according to experts. Test ordering for preventive health care among family medicine residents.
Daisy Fung, MD Inge Schabort, MB ChB Catherine A.
MacLean, MD MClSc MBA Farhan M. Asrar, MD MSc MPH Ayesha Khory, MD Ben Vandermeer, MSc G. Test ordering for preventive health care among family medicine residents. Objective To determine which screening tests family medicine residents order as part of preventive health care.
Design A cross-sectional survey. Setting Alberta and Ontario. Participants First- and second-year family medicine residents at the University of Alberta in Edmonton, the University of Calgary in Alberta, and McMaster University in Hamilton, Ont, during the 2011 to 2012 academic year. Promoting Patient-Centered Counseling to Reduce Use of Low-Value Diagnostic Tests: A Randomized Clinical Trial. Importance Low-value diagnostic tests have been included on primary care specialty societies’ “Choosing Wisely” Top Five lists.
Objective To evaluate the effectiveness of a standardized patient (SP)-based intervention designed to enhance primary care physician (PCP) patient-centeredness and skill in handling patient requests for low-value diagnostic tests. Design, Setting, and Participants Randomized clinical trial of 61 general internal medicine or family medicine residents at 2 residency-affiliated primary care clinics at an academic medical center in California. Interventions Two simulated visits with SP instructors portraying patients requesting inappropriate spinal magnetic resonance imaging for low back pain or screening dual-energy x-ray absorptiometry. Training the Next Generation of Doctors in Palliative Care I...