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Six Things Medical Students and Trainees Should Question

Choosing Wisely Canada Campaign aims to change the culture of medical education by addressing behaviours that can lead to unnecessary care.

In early November, I had the chance to speak at a gathering of medical students from across the country. They were brought together for the inaugural meeting of the Choosing Wisely Canada Students & Trainees Advocating for Resource Stewardship (STARS).

Choosing Wisely Canada is a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures. Unnecessary testing does not add value to care and puts a strain on our resources – but beyond that, it can also expose patients to harm. Choosing Wisely is being taken up by countries worldwide with campaigns already launched in the United States, Australia, Italy and the United Kingdom, and at least ten other countries are interested in developing campaigns.

Choosing Wisely Canada has up until now focused its’ attention on working with practicing physicians to develop lists of recommendations of tests, treatments and procedures that are overused or unnecessary in their specialty. STARS is Choosing Wisely Canada’s latest undertaking to get medical students involved in the campaign. It is a grassroots, student-led campaign to introduce more content around resource stewardship (meaning the responsible planning and management of health care) to undergraduate, postgraduate and continuing education and to raise awareness about unnecessary care among medical students.

In kicking off STARS in November, there was an impressive group of future physicians and a lot of energy in the room. You can watch a video of highlights from the day here.

The students released a list entitled, “Six Things that Medical Students and Trainees Should Question”. This list includes a group of statements aimed not only at learners, but also at physicians already practicing – particularly those engaged in teaching and training.

Spearheaded by a group of University of Toronto students, the list was developed using a survey sent to all medical students in Canada, and nearly 2,000 provided input. It seeks to change the culture of medical education by addressing the behaviours that can lead to unnecessary care. By fostering an environment in medical education where leaders – and teachers – can speak about uncertainties and challenge or question when testing or treatments do more harm than good, our entire health system will function at a higher level of quality, with more patients and people reaching their full health potential.

Here is the list:

  1. Don’t suggest ordering the most invasive test before considering other less invasive options.
  2. Don’t suggest a test, treatment, or procedure that will not change the patient’s clinical course.
  3. Don’t hesitate to ask for clarification on tests, treatments, or procedures that you believe may be ordered inappropriately.
  4. Don’t miss the opportunity to initiate conversations with patients about whether a test, treatment or procedure is necessary.
  5. Don’t suggest ordering tests or performing procedures for the sole purpose of gaining personal clinical experience.
  6. Don’t suggest ordering tests or treatments pre-emptively for the sole purpose of anticipating what your supervisor would want.

As with the broader Choosing Wisely Canada campaign, STARS will need to be carefully evaluated to ensure it is actually changing patient outcomes. However, it is off to a good start with a strong commitment of tomorrow’s doctors to provide the best possible care for their patients.

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