Problem: Physician behaviors that promote overuse of health care resources develop early in training, and the medical education environment helps foster such behaviors. The authors describe the development of a Choosing Wisely list for medical students aimed at helping to curb overuse.
Approach: The list was developed in 2015 by Choosing Wisely Canada (CWC) in partnership with the Canadian Federation of Medical Students and the Fédération médicale étudiante du Québec, which together represent all medical students in Canada. CWC convened a student-led taskforce to develop recommendations targeting medical student behaviors with respect to resource stewardship practices. Students at all 17 Canadian medical schools were consulted via an online questionnaire to solicit feedback on a list of 10 candidate recommendations. The taskforce used this student feedback in finalizing the list.
Outcomes: The final list of “Six Things That Medical Students and Trainees Should Question” highlights both behaviors students should avoid (e.g., “Don’t suggest ordering the most invasive test before considering other less invasive options”) and behaviors related to aspects of medical training that may promote overuse, such as the hierarchical nature of clinical supervision (e.g., “Don’t hesitate to ask for clarification on tests, treatments, or procedures that you believe may be ordered inappropriately”). Based on student requests for illustrative examples, clinical vignettes were developed.
Next Steps: This list highlights medical student behaviors and aspects of the academic environment that drive overuse. It is also relevant to faculty, whose behaviors and supervision practices influence trainees.
A. Lakhani is a second-year medical student, University of Toronto, Toronto, Ontario, Canada.
E. Lass is a third-year medical student, University of Toronto, Toronto, Ontario, Canada.
W.K. Silverstein is a third-year medical student, University of Toronto, Toronto, Ontario, Canada.
K.B. Born is knowledge translation lead, Choosing Wisely Canada, and assistant professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
W. Levinson is chair, Choosing Wisely Canada, and professor of medicine, University of Toronto, Toronto, Ontario, Canada.
B.M. Wong is medical education lead, Choosing Wisely Canada, and associate professor of medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
The authors have informed the journal that they agree A. Lakhani, E. Lass, and W.K. Silverstein completed the intellectual and other work typical of the first author.
Funding/Support: None reported.
Other disclosures: None reported.
Ethical approval: The University of Toronto research ethics board deemed this process exempt from full review.
Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A380.
Correspondence should be addressed to Brian M. Wong, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room H466, Toronto, ON M4N 3M5, Canada; telephone: 416-480-6100, ext 83709; e-mail: BrianM.Wong@sunnybrook.ca.