By Neel T. Shah, MD
Back in April, Costs of Care partnered with the ABIM Foundation to launch the Teaching Value & Choosing Wisely Competition, an effort to crowd-source ideas on ways to teach medical students and residents about high-value care. In prior posts on Wing of Zock, we pointed out that although learning how to deliver value is more important than ever, previous attempts to teach value have been unsuccessful. We hypothesized that medical educators have been thwarted for more than four decades by fickle political and public will demanding a higher-performing system.
In 2010, everything changed. The Patient Protection and Affordability Act (“Obamacare”) was signed into law; smartphones (and the on-demand consumer transparency they enable) became ubiquitous; and the medical profession began to step into action. By 2012, the IOM wrote Best Care at Lower Costs and the ABIM Foundation created the Choosing Wisely Campaign. The time to begin closing the gap in medical education had arrived.
We suspected many medical educators were already finding innovative ways to teach trainees about value and that eager trainees likely harbored many ideas of their own. We were right. Last month, the Teaching Value & Choosing Wisely Competition collected 74 submissions from across the country, including 27 projects that have already been implemented and 47 new “bright ideas.” We heard from attendings, fellows, residents, and students. Represented specialties included internal medicine, pediatrics, ob/gyn, family medicine, emergency medicine, general surgery, orthopedic surgery, neurosurgery, and physical therapy.
Many ideas cleverly build on existing teaching methods, including incorporating a value dimension to pre-clinical problem-based learning, journal clubs, formal didactics, routine conferences, and even clinical rotations. Others track resource utilization and even billing data to drive practice-based improvement. Particularly creative approaches leverage behavioral economics to encourage high-value social norms in the practice environment, gamification to drive value-based competition, and information technology systems to help trainees navigate the complexity of value considerations.
Over the next few weeks, the Costs of Care education team (including myself and frequent Wing of Zock contributors Vineet Arora and Chris Moriates) will be reviewing the submissions and working with the competition judges (including the AAMC’s very own Joanne Conroy) to identify particularly promising ideas in terms of scalability and impact. Leading up to the AAMC annual meeting in November 2013, the ABIM Foundation will invite select competition participants to attend a conference of top medical educators in order to discuss next steps.
Although there is much work to be done, we are tremendously excited by this early step. The competition offered an opportunity to identify and bring together a progressive community of leading medical educators who are driving a movement to improve the value of American health care delivery. In the near future, we will be building a learning network at TeachingValue.org that will serve as a virtual ongoing conference for sharing ideas, building collaborations, and delivering tools. Registration on the website is free. If you would like to join us, we would love to have you.
—Dr. Neel Shah is the executive director of Costs of Care, an independent nonprofit that helps patients and their caregivers deflate medical bills. He is also an ob/gyn based at Beth Israel Deaconess Medical Center and an investigator at Ariadne Labs. He can be reached at email@example.com.