The ABIM Foundation announced the recipients of its new Putting Stewardship into Medical Education and Training grant program. The six winning proposals are designed to create new training program initiatives or expand existing ones to focus on potential negative consequences associated with unneeded care and, in doing so, reduce the overuse of certain tests and treatments.
This work will build upon current ABIM Foundation efforts, including Choosing Wisely® and The Teaching Value and Choosing Wisely Challenge, which recognizes innovative efforts in medical education to promote stewardship.
Both clinical training programs in medicine, nursing or other allied health professions and delivery systems that support clinical training programs were eligible for Putting Stewardship into Medical Education and Training grants. The following initiatives were selected to receive $25,000 to implement innovative and scalable interventions:
- Albert Einstein College of Medicine and The Warren Alpert Medical School of Brown University – The two institutions will jointly create a value-based practice curriculum to teach stewardship knowledge, skills and attitudes. They will develop a standard Objective Structured Clinical Examination (OSCE) based on the Choosing Wisely recommendations linked to antibiotic stewardship and then use it to assess student competencies in appropriate antibiotic prescribing and patient-centered counseling for upper respiratory infections.
- Choosing Wisely Canada/University of Toronto – As the international reach of Choosing Wisely grows, Choosing Wisely Canada is reaching out to medical students from coast to coast. Choosing Wisely Canada STARS (Students and Trainees Advocating for Resource Stewardship) will raise awareness about resource stewardship among medical students and empower them to reduce overuse. The grassroots initiative involves identifying students from all of Canada’s medical schools to lead local campaigns. This includes convening a leadership summit of medical students, developing an online community and creating a toolkit for local action.
- Oregon Health & Science University (OHSU) – OHSU will seek to expand the content of its telemedicine OSCE and simulated electronic medical record technologies to address Choosing Wisely topics, including patient-provider communication and stewardship of diagnostic resources. OHSU will implement its Choosing Wisely simulation education in its Family Medicine clerkship to target five potentially unnecessary tests and treatments in primary care.
- Penn State College of Medicine, Case Western Reserve University, Louis Stokes Cleveland VA Medical Center and Harvard Medical School– The institutions plan to build SOAP-V (Subjective-Objective-Assessment-Plan plus “value”) into frameworks for progress notes and daily patient presentations to remind clinicians to include value in their point-of-care decision making. The goal is to expand SOAP-V to outpatient settings for internal medicine residents and to examine its impact on test-ordering behaviors. Following training in the use of SOAP-V, residents will be asked to use SOAP-V at least once daily during the ambulatory block.
- The Mount Sinai Hospital – The proposal will continue the Overuse Clinical Case Morbidity & Mortality (OCCAM) Conference and introduce it to nurse practitioners (NPs) and physician assistants (PAs) at Memorial Sloan Kettering Cancer Center. Students, residents, NPs and PAs will discuss cases, evidence-based articles and the cost of care, with the goal of reducing unnecessary utilization. The results of each session will be recorded and shared with the OCCAM Workgroup, which will develop value improvement and patient safety initiatives from these adverse events.
- University of Minnesota – The project will expand curriculum to incorporate faculty-led clinical practice audits for all trainees on inpatient general internal medicine services. These audits will track team utilization of telemetry and low-value lab services, including complete blood counts and A1c testing, in order to increase trainees’ recognition of overuse and ultimately improve stewardship of resources.
In addition to their projects, grantees will also participate in the Teaching Value in Health Care Learning Network, created by Costs of Care and the ABIM Foundation to share ideas and collaborate in the development of learning strategies in medical education and training. The learning network is open to medical residents, students, faculty and others who are committed to advancing stewardship competencies and high-value care. It features monthly “Third Thursday” webinars with leaders in medical education to highlight implementation models and innovations in value-based training.