Better Health Greater Cleveland Helps Teach Medical Students and Residents ‘Less Is More’

To ensure the sustainability of the nation’s health care system, future physicians will be increasingly required to practice in environments that ask them to be good stewards of finite resources. With its focus on facilitating thoughtful conversations around reducing overuse, the Choosing Wisely^® campaign has been embraced by the medical education and training community. Better Health Greater Cleveland – a grantee of the ABIM Foundation – is developing educational modules to help medical students and residents think about overuse while they’re still in training.

Better Health GreaterCleveland is a regional health care collaborative whose members include health care systems, health plans, employer groups and community organizations. Their work focuses on improving health care, health and reducing cost by providing high-quality and appropriate care.

One recent focus of their work addresses education for physician trainees about waste, overuse and its potential harm. A growing interest in education that targets unnecessary care is reflected in features and articles in clinical journals such as the “Teachable Moments” and “Less is More” series from JAMA Internal Medicine.  A reported 85 percent of program directors believe graduate medical education has a responsibility to curtail rising costs of care; however, only 15 percent report having a formal curriculum built on cost-conscious care. With the Accreditation Council of Graduate Medical Education’s (ACGME) addition of milestones around cost-conscious care, graduate medical education and residency programs are fertile ground to begin the transformation of physician and patient culture to “less is more.”

“The Choosing Wisely campaign represents a very new age of medicine,” said Donald Ford, MD, Assistant Professor of Medicine at the Cleveland Clinic Lerner College of Medicine. “We are looking at what we’ve done for years, and we’re looking at whether it is worth doing – whether it is truly good for the patient.”

To educate the next generation of physicians, Better Health Greater Cleveland is developing classroom-ready educational modules for residents and medical students on five common health complaints that often spur unnecessary tests or treatments. Each module will introduce students to the Choosing Wisely campaign and provide information on the individual recommendations from specialty societies. The modules will include:

• scenarios of provider-patient encounters that can be paired with a facilitated group discussion;
• a case using a standardized patient;
• an evaluation tied to ACGME milestones;
• a self-reflection activity;
• video with local subject matter experts; and,
• accompanying slides.

Versions of the modules will be available for both teachers and learners, and are designed so that the individual components can be used separately or together as part of a curriculum.

The first completed module focuses on patient complaints of lower back pain. Future units will focus on overuse of imaging for headaches, antibiotics and imaging for sinus infections, Pap tests and cardiac testing.

“We’ve worked to provide practical tools that educators and learners can readily incorporate into their training,” said Aleece Caron, PhD, project director of Better Health Greater Cleveland’s Choosing Wisely program. “We know that learning about inappropriate care is just as important as learning about appropriate care – and not just because of wasted health care resources. High-quality care is about every patient getting the right care at the right time, no less and no more.”

For more information on these modules, email info@betterhealthcleveland.org.