The Clerkship Wisely podcast created by Annalise Manley, a medical student at Oregon Health & Science University, is a resource for third-year medical students to learn how to incorporate cost-conscious care into their clerkship rotations using Choosing Wisely.
The first episode features Christopher Moriates, MD, hospital medicine physician at University Medical Center Brackenridge, Assistant Dean for Healthcare Value and Associate Professor of Internal Medicine at Dell Medical School at UT Austin, and Director of the US STARS Program. Throughout their conversation, Manley and Moriates discuss the importance of high-value care and their experiences implementing Choosing Wisely.
Ms. Manley talked with us about her experience starting the podcast and the first episode.
Clerkship Wisely Podcast
What served as your inspiration for creating Clerkship Wisely?
When I was interviewing for medical school, I read “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care” by T.R. Reid in anticipation of some of the health policy questions I might be asked. This book served as my first introduction to problems of waste, inefficiency, and inequality in the U.S. health care system. I was shocked to learn just how expensive our system is compared to other industrialized nations, and that much of that cost is due to spending that does not improve patient outcomes. So when I had the opportunity to participate in the first year of the US STARS programs as a first-year medical student, I eagerly applied. There, I learned about Choosing Wisely, and the impact that changes made through direct patient care at the individual level can have on the waste in our system.
It became clear that considering cost and value in medical decision making is a central part of being a physician, but I did not see these considerations explicitly addressed in my medical school curriculum. I wanted to create a resource to introduce my peers to this concept in a way that was engaging, easily accessible and relevant to medical students. Ultimately, this led to “Clerkship Wisely,” a podcast with episodes featuring faculty guests from each core clinical rotation discussing the corresponding specialty society’s Choosing Wisely guidelines.
How do you continue to learn in order to stay on top of Clerkship Wisely?
My goal in creating this podcast was not to teach students everything they need to know about high-value care. Rather, I wanted to introduce established resources and encourage making a habit out of identifying common sources of misuse and overuse in every clinical rotation. I try to adhere to this objective personally, and have made a practice of skimming the Choosing Wisely recommendations before starting a rotation.
What advice would you provide to medical students interested in high-value care?
First of all, I think that even having an awareness of high-value care is a huge first step. In addition to using Choosing Wisely as a personal learning tool, I’ve also found it immensely helpful to try and understand the “why” behind the recommendations made during rotations. For me, being able to describe why a certain intervention or diagnostic test is indicated for a specific patient compared to the alternatives not only helps me better understand the medicine behind the recommendation, but also helps to identify care that is truly necessary. Lastly, I would encourage students to advocate within their medical school to incorporate more training on addressing cost and value in their curriculums.
Right now, my immediate plans include finishing episodes for the OB/GYN, Neurology and Psychiatry clerkships.
What do you consider the most noteworthy point made during your podcast featuring Dr. Moriates?
For me, I think one of the central points raised by Dr. Moriates is the importance of approaching each patient as an individual, and to consider the Choosing Wisely guidelines in the context of each patient’s unique needs. Rather than viewing the guidelines as a hard rule of something to never do, he encouraged using them as a starting point to critically think about what is necessary for a given patient’s evaluation and treatment plan. I think this approach helps build a strong foundation for creating a pattern of thinking that will better identify misuse and overuse in instances that don’t have specific guidelines.
Similarly, centering our decisions around each individual helps to remind us that our actions have very real impacts on the lives of those we treat. As Dr. Moriates pointed out, it can be overwhelming to always consider cost and value on the scale of the entire health care system. Remembering that our judicial use of resources directly influences the financial burden our patients face, and may even prevent adverse health outcomes, provides a tangible reminder of the importance of practicing high-value care in every encounter.
Please tell us your thoughts on the STARS program, including its role in increasing high-value care.
I am so grateful to have had the opportunity to participate in the STARS program, and feel that it was especially impactful to do as a first year medical student. It provided me with a foundational understanding of high-value care, and gave me tools to build upon that understanding throughout medical school. I also believe that empowering students to initiate change at their schools is especially effective, as students often have the best understanding of their unique curricula and know what type of changes will be the most realistic and effective for their school. I am so happy to hear that the program has continued to grow, and this project finally coming to fruition years later is evidence of the lasting impact STARS has had on me.