Canadian medical student perceptions of the Choosing Wisely Canada campaign

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DOI:

https://doi.org/10.36834/cmej.74645

Abstract

Background: Medical student investment in resource stewardship (RS) is essential as resource overuse continues among physicians, but it is unclear whether this is influenced by hidden curriculum. This study investigated medical student perceptions of Choosing Wisely Canada (CWC).

Methods: Canadian Medical students completed a bilingual questionnaire. Chi-square and student’s T-tests were used to analyze Likert responses capturing student attitudes toward questions grouped by theme, including the importance of the CWC campaign, the amount of CWC represented in undergraduate medical curriculum, the application of CWC recommendations in medicine, and the barriers which exist to student advocacy for CWC in practice.

Results: There were 3,239/11,754 (26.9%) respondents. While most students (n = 2,720/3,171; 85.8%) endorsed the importance of CWC, few students felt that their institution had sufficiently integrated CWC into pre-clerkship (47.0%) and clerkship (63.5%) curricula. Overall, 61.4% of students felt that it is reasonable to expect physicians to apply CWC recommendations given the workplace culture in medicine. Only 35.1% of students were comfortable addressing resource misuse with their preceptor. The most common barriers included the assumption that their preceptor was more knowledgeable (86.4%), concern over evaluations (66.0%), and concern for their reputation (31.2%). 

Conclusions: Canadian medical students recognize the importance of CWC. However, many trainees feel that the workplace culture in medicine does not support the application of CWC recommendations. A power imbalance exists that prevents students from advocating for RS in practice.

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References

Vogel L. Nearly a third of tests and treatments are unnecessary: CIHI. CMAJ. 2017;189(16):e620-e621. https://doi.org/10.1503/cmaj.1095417

Levinson W, Huynh T. Engaging physicians and patients in conversations about unnecessary tests and procedures: Choosing Wisely Canada. CMAJ. 2014;186(5):325-326. https://doi.org/10.1503/cmaj.131674

Cardone F, Cheung D, Han A, et al. Choosing Wisely Canada Students and Trainees Advocating for Resource Stewardship (STARS) campaign: a descriptive evaluation. CMAJ Open. 2017;5(4):e864-e871. https://doi.org/10.9778/cmajo.20170090

Levinson W, Kallewaard M, Bhatia RS, Wolfson D, Shortt S, Kerr EA. “Choosing Wisely”: a growing international campaign. BMJ Qual Saf. 2015;24(2):167-174. https://doi.org/10.1136/bmjqs-2014-003821

Embrett M, Randall GE. Physician perspectives on Choosing Wisely Canada as an approach to reduce unnecessary medical care: a qualitative study. Health Res. Policy Syst. 2018;16(1):95. https://doi.org/10.1186/s12961-018-0370-5

Zikmund-Fisher BJ, Kullgren JT, Fagerlin A, Klamerus ML, Bernstein SJ, Kerr EA. Perceived Barriers to Implementing Individual Choosing Wisely Recommendations in Two National Surveys of Primary Care Providers. J. Gen. Intern. Med. 2017;32(2):210-217. https://doi.org/10.1007/s11606-016-3853-5

Born KB, Coulter A, Han A, et al. Engaging patients and the public in Choosing Wisely. BMJ Qual Saf. 2017;26(8):687-691. https://doi.org/10.1136/bmjqs-2017-006595

Lin MP, Nguyen T, Probst MA, Richardson LD, Schuur JD. Emergency Physician Knowledge, Attitudes, and Behavior Regarding ACEP’s Choosing Wisely Recommendations: A Survey Study. Acad Emerg Med. 2017;24(6):668-675. https://doi.org/10.1111/acem.13167

Pakyz AL, Moczygemba LR, Vanderwielen LM, Edmond MB, Stevens MP, Kuzel AJ. Facilitators and barriers to implementing antimicrobial stewardship strategies: Results from a qualitative study. Am. J. Infect. Control. 2014;42(10):s257-S263. https://doi.org/10.1016/j.ajic.2014.04.023

Ross J, Santhirapala R, MacEwen C, Coulter A. Helping patients choose wisely. BMJ. 2018;361(June):k2585. https://doi.org/10.1136/bmj.k2585

Cayea D, Tartaglia K, Pahwa A, Harrell H, Shaheen A, Lang VJ. Current and optimal training in high-value care in the internal medicine clerkship: a national curricular needs assessment. Acad Med. 2018;93(10):1511-1516. https://doi.org/10.1097/ACM.0000000000002192

Hunderfund ANL, Dyrbye LN, Starr SR, et al. Role Modeling and Regional Health Care Intensity: U.S. Medical Student Attitudes Toward and Experiences with Cost-Conscious Care. Acad Med. 2017;92(5):694-702. https://doi.org/10.1097/ACM.0000000000001223

Stammen LA, Stalmeijer RE, Paternotte E, et al. Training physicians to provide high-value, cost-conscious care a systematic review. JAMA. 2015;314(22):2384-2400. https://doi.org/10.1001/jama.2015.16353

Sirovich BE, Lipner RS, Johnston M, Holmboe ES. The association between residency training and internists’ ability to practice conservatively. JAMA Intern. Med. 2014;174(10):1640-1648. https://doi.org/10.1001/jamainternmed.2014.3337

Lakhani A, Lass E, Silverstein WK, Born KB, Levinson W, Wong BM. Choosing wisely for medical education: six things medical students and trainees should question. Acad Med. 2016;91(10):1374-1378. https://doi.org/10.1097/ACM.0000000000001325

Tchou MJ, Dewan M, Herrmann LE. Confronting the Hidden Curriculum of High-Value Care Education. Hosp. Pediatr. 2018;8(3):173-175. https://doi.org/10.1542/hpeds.2017-0248

Ludwig S, Schuelper N, Brown J, Anders S, Raupach T. How can we teach medical students to choose wisely? A randomised controlled cross-over study of video- versus text-based case scenarios. BMC Med. 2018;16(1):1-9. https://doi.org/10.1186/s12916-018-1090-y

Association of Faculties of Medicine of Canada. Canadian Medical Education Statistics 2019. 2019;41:117-121.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbrouckef JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Bull. World Health Organ. 2007;85(11):867-872. https://doi.org/10.2471/BLT.07.045120

Ramsay D, Bolous Y, Huo B, McDermott EE, Campbell SG. The effectiveness of an interprofessional education course in teaching the importance of Choosing Wisely and resource stewardship: a pilot study. Cureus. 2021;13(5):e14850. https://doi.org/10.7759/cureus.14850

Desrochers JE, Albert G, Milfont TL, Kelly B, Arnocky S. Does personality mediate the relationship between sex and environmentalism? Pers Individ Differ. 2019;147:204-213. https://doi:10.1016/j.paid.2019.04.026

Vogel L. Medical students now choosing wisely. CMAJ. 2016;188(1):17. https://doi.org/10.1503/cmaj.109-5198

Vaughn VM, Szymczak JE, Newton DW, Fakih MG. Addressing the overuse of cultures to optimize patient care. Ann. Intern. Med. 2019;171(7):s73-S75. https://doi.org/10.7326/M18-3442

Bell A, Cavanagh A, Connelly C, Walsh A. Why do few medical students report their experiences of mistreatment to administration? Med. Educ. 2020;55(4):462-470. https://doi.org/10.1111/medu.14395

Pahwa A, Cayea D, Bertram A, et al. Student perceptions of high-value care education in internal medicine clerkships. J Hosp Med. 2017;12(2):102-103. https://doi.org/10.12788/jhm.2689

Muntyanu A, Jebanesan D, Kuling P. Choosing Wisely: resource stewardship education in Canadian Medical Schools. UOJM. 2017:7-8. https://doi.org/10.18192/uojm.v7i1.1818

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Published

2022-09-01

How to Cite

1.
Huo B, Bolous Y, Ramsay D, McDermott E, Sandila N, Campbell S. Canadian medical student perceptions of the Choosing Wisely Canada campaign. Can. Med. Ed. J [Internet]. 2022 Sep. 1 [cited 2024 Nov. 18];14(3):14-32. Available from: https://journalhosting.ucalgary.ca/index.php/cmej/article/view/74645

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Original Research