Putting Stewardship Into Medical Education and Training

The six winning proposals of the 2015 Putting Stewardship into Medical Education and Training grant program will create new training program initiatives or expand existing ones to focus on potential negative consequences associated with unneeded care with the goal of reducing the overuse of certain tests and procedures.

The following recipients received $25,000 for the two-year grant:

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 will tap students from all of Canada’s medical schools to lead local campaigns. Choosing Wisely Canada will also convene a leadership summit of medical students, developing an online community and creating a toolkit for local action.

Oregon Health & Science University (OHSU) plans to expand the content of its telemedicine Objective Structured Clinical Examination (OSCE) and simulated electronic medical record (EMR) technologies to address Choosing Wisely topics, including patient-provider communication and stewardship of diagnostic resources. OHSU plans to implement its Choosing Wisely simulation education in its Family Medicine clerkship to target five potentially unnecessary tests and treatments in primary care.

Albert Einstein College of Medicine and The Warren Alpert School of Medicine of Brown University will jointly create a value-based practice curriculum to teach Choosing Wisely knowledge, skills and attitudes. They will develop a standard 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.

Penn State College of MedicineCase Western Reserve UniversityLouis Stokes Cleveland VA Medical Center and Harvard Medical School 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.

Mount Sinai Hospital will continue the OCCAM’s (Overuse Clinical Case Morbidity & Mortality) Conference and introduce it to nurse practitioners and physician assistants at Memorial Sloan Kettering Cancer Center. Students, residents, NPs and PAs will discuss cases, evidence-based articles and costs of care to reduce 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 Medical School will expand curricula 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.