The Wisdom of the Crowd: Finding the Most Promising Innovations to Teach Value

teaching_values_projectBy Vineet Arora, MD

Earlier this year, we launched the Teaching Value and Choosing Wisely Competition in conjunction with Costs of Care and the ABIM Foundation. Why a competition?  Not surprisingly, traditional “literature review” yielded little by way of promising strategies for educators who wished to learn how to teach about value. However, we all had learned of isolated stories of success, occasionally through attending professional meetings, sometimes via networking with colleagues, or more often through word of mouth.

To help bring these stories of success to the fore, we relied on a crowdsourcing model by launching a competition to engage a larger community of individuals to tell us their stories. Of course, there were moments we wondered if we would get any submissions. Fortunately, we didn’t have anything to worry about! In June, we received 74 submissions from 14 specialties, with innovations and bright ideas that targeted medical students, residents, faculty, and interprofessional learners.

Reviewing each abstract to determine the most promising practices that could be easily scaled up to other institutions was not an easy task. One interesting struggle was the inherent trade-off between feasibility and novelty: What was feasible may not have been so novel, while you were left wondering whether the most innovative abstracts would be feasible to implement. Fortunately, due to the outstanding expert panel of judges, we were able to narrow the field.

While all the submissions were interesting and worthy in their own right, it was clear that there were some that rose to the top. For example, while every submission included some level of training, the most promising employed methods beyond traditional training, such as a systems fix using electronic health records, a cultural change through valuing restraint, or oversight or feedback mechanisms to ensure trainees get the information they need to assess their practice at the point of care.

Perhaps it is not surprising that several of our winners are trainees or medical students.  After all, junior learners are on the sharp end of patient care and in the position to see the simplest and most elegant solutions to promote teaching value. Giffin Daughtridge, a second-year medical student at the University of Pennsylvania, proposed linking third-year medical students to actual patients to review not only their histories but also their actual medical bills. As emergency medicine residents at NYU, Michelle Lin and Larissa Laskowski were inspired by Hurricane Sandy to develop an easy-to-use curricular program for their peers. While serving as chief resident at Yale, Robert Fogerty instigated a friendly competition among medical students, interns, residents, and attending physicians to reach the correct diagnosis with the fewest resources possible during morning report–style conferences.

The methods were equally diverse, from repurposing traditional tools to using new methods altogether. Building on the traditional clinical vignette, Tanner Caverly and Brandon Combs launched the “Do No Harm Project” at the University of Colorado to collect vignettes about value. This program also informed the launch of “Teachable Moments” section in JAMA Internal Medicine that is now accepting submissions from trainees. Meanwhile, Amit Pahwa, Lenny Feldman, and Dan Brotman from Johns Hopkins University proposed individualized dashboards that would make lab and imaging use for each trainee available for feedback and benchmarking against their peers. Steven Brown and Cheryl O’Malley at Banner Health proposed a local high-value competition that resulted in more than 40 entries from trainees. Drs. Brown and O’Malley plan to implement the most promising ones.

These are just a few of the innovations and bright ideas that were submitted. You can check out the entire list on the Teaching Value forum. Our hope is that this is just the start of developing a network of people interested in working together to transform medical education by incorporating principles of stewardship.

hsbwkyz2_Arora_Vineet_ILVineet Arora, MD, MAPP on behalf of the Teaching Value Team including Chris Moriates, MD; Andy Levy, MD; and Neel Shah, MD, MPP.