By Catherine Smith
Catherine Smith, MS, is a second-year student interested in Obstetrics & Gynecology. She is passionate about academic medicine and involving students in the curriculum development process.
Like a pebble creating ripples in a lake, one individual (or in this case a handful of Choosing Wisely devotees) can help generate the change we need in healthcare. I had the opportunity to attend the inaugural Choosing Wisely STARS Summit in December 2017 as a first-year medical student. After the summit, my fellow student-attendee and I knew we wanted to increase student awareness of the campaign at Eastern Virginia Medical School (EVMS). The challenge was to figure out how to institute lasting change on curriculum and culture.
We approached our mentors at EVMS with two well-documented facts:
- Healthcare overspending has become such a considerable issue that waiting until residency to discuss the individual physician’s role in reducing spending is impractical and ill-advised.
- There are plenty of opportunities for incorporating Choosing Wisely and/or high-value care threads into undergraduate medical education (UME) without disrupting existing curriculum or preparedness for residency.
Our mentors agreed with these sentiments and encouraged us to look for opportunities to introduce the tenets of Choosing Wisely into our curriculum. We spent our summer working on a competency model for incorporating its principles into UME as well as identifying opportunities to expand the high-value care curriculum at EVMS.
One of the initiatives that we have established is an annual Choosing Wisely Day. The goal of the event is to boost student awareness of the campaign via a keynote address as well as collegial challenges to engage students at all levels in conversations on high-value care.
Our first Choosing Wisely Day took place last November, and was widely considered a success. 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. Our keynote speaker, Dr. Amit Pahwa, a well-known high-value care expert from Johns Hopkins School of Medicine, shared a wealth of knowledge with our graduate and undergraduate medical trainees.
We asked our UME interest groups to make posters of their “Top 5” Choosing Wisely recommendations, which are now displayed in our lounges and provide our UME trainees with an opportunity to engage the attending physicians and residents in a conversation on value. An innovation challenge, modeled after the popular television show “Shark Tank,” yielded several ideas on how to address healthcare overspending. We also hosted the American College of Radiology (ACR), whose representatives prepared several Choosing Wisely-based cases and taught students to use its clinical decision support tool to aid in providing high-value care.
By increasing student awareness of Choosing Wisely, we hope to empower students to use recommendations supported by medical specialty societies to advocate for patients. Ultimately, we hope graduates of EVMS will practice cost-conscious care and will feel comfortable having conversations about value. These empowered students will challenge healthcare teams to maximize value and minimize cost.
The annual STARS summit empowers first-year medical students across the United States and Canada to raise awareness about Choosing Wisely at their institutions. At the summit, we were asked rhetorically: who better to host initiatives, generate student body excitement, and make suggestions for curricular change than a student experiencing the curriculum in real time?
Based on our experience, EVMS students and faculty would respond with a resounding “We agree!” A student’s place in medical education is not just in front of a computer screen, but on steering committees and in curriculum retreats. By enabling students to raise awareness of Choosing Wisely, we help to create the future generation of value-conscious health care providers.