Modern culture sometimes supports the notion that more is better. But most of us can probably spot the flawed thinking behind these statements: More money equals more happiness. More free time means more personal fulfillment. More food options equal better diets.
The idea that more is better when it comes to diagnostic tests in health care fails to recognize that unnecessary tests can expose patients to unwarranted harm and risk. It also does not take into account that ordering unnecessary tests strains already limited health care resources.
“The CanMEDS 2015 Physician Competency Framework has highlighted stewardship of health care resources as a key competency for all physicians,” said Dr. Ming-Ka Chan, Clinician Educator & Associate Professor in Pediatrics and Child Health with the University of Manitoba. “Medical schools, residency and continuing professional development programs may need to put greater emphasis on ensuring that resource stewardship is integrated into curricula.”
This past summer, Diagnostic Services Manitoba provided funding through its new Summer Studentship program to support a project that reviewed the pre-clerkship medical school curriculum in Manitoba with an eye to making recommendations about where the Manitoba curriculum could be revised or enhanced with resource stewardship and Choosing Wisely principles and then developing appropriate materials. Medical students Andrea Kulyk and Youn Tae Chung were part of a resource stewardship student interest group at the Max Rady College of Medicine, so the project was a natural extension of their interests.
“As medical students, we’re concerned with the future of health care,” said Kulyk. “We’re hoping that this project will help to shift the current medical culture by fostering awareness in medical students and encouraging them to develop evidence-based skills they can use throughout their career.”
“It’s not just about saving money,” added Chung. “It’s about making informed decisions based on available evidence to ensure high value care. More is not always better in medicine.”
The students’ project is two-fold. In the first part, which was completed over summer, the students analyzed the curriculum and identified ways to improve it with resource stewardship principles and Choosing Wisely recommendations. They developed learning materials such as lecture slides, online modules and team-based learning sessions. During this phase, they also established relationships with key stakeholders including the Undergraduate Dean, Pre-Clerkship Committee, course directors and other students.
“The students’ project resulted in the integration of 120 Choosing Wisely recommendations into the curriculum,” said Dr. Ira Ripstein, Associate Dean of Undergraduate Medical Education at the University of Manitoba. “We think this curriculum improvement has the potential to strengthen medical practice in Manitoba over the long-term.”
The second phase of the project will be to evaluate the effectiveness of the materials they created on students’ knowledge of and attitude toward resource stewardship in health care. The students surveyed a group of pre-clerkship students to establish a baseline this past September and will re-assess student awareness and thoughts in May 2017.
“We are excited to see the results of integrating the concepts of resource stewardship and appropriate use into the medical curriculum and the changes this could have on new doctors,” said Dr. Eric Bohm, Director of Health Systems Performance with the Centre for Healthcare Innovation and Associate Professor of Surgery at the University of Manitoba, who co-supervised the students’ project with Dr. Chan. “The idea is to build support for resource stewardship from the bottom-up so it becomes engrained in how doctors practice medicine.”
Choosing Wisely Change Makers
Read more about the success Manitoba has had with Choosing Wisely initiatives in a feature article by Choosing Wisely Canada – The Manitoba Advantage and Choosing Wisely