{"id":40908,"date":"2017-12-18T18:13:26","date_gmt":"2017-12-18T17:13:26","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=40908"},"modified":"2017-12-20T10:43:07","modified_gmt":"2017-12-20T09:43:07","slug":"karen-b-born-et-al-learning-how-to-choose-wisely","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/12\/18\/karen-b-born-et-al-learning-how-to-choose-wisely\/","title":{"rendered":"Karen B Born et al: Learning how to choose wisely"},"content":{"rendered":"

Across the<\/span>\u00a0countries with Choosing Wisely campaigns<\/span><\/a>, thousands of recommendations of “Things clinicians and patients should question” have been published. These lists and recommendations, familiar to many practising clinicians, outline tests, treatments, or procedures that evidence suggests are overused, unnecessary and may cause harm to patients. <\/span>As some have pointed out,<\/span><\/a> implementing these recommendations into practice can be <\/span>challenging<\/span><\/a> and <\/span>slow<\/span><\/a>. <\/span><\/p>\n

However, there are a new cluster of recommendations which are being published, not by national clinical specialty societies, but by national medical student associations. These lists of recommendations do not focus on specific tests, treatments, and procedures that are overused, but rather on the training environment and culture that foster overuse. Medical student leaders are sharing the same message that reducing overuse begins in training. <\/span><\/p>\n

Choosing Wisely lists for medical students and trainees create opportunities for students to initiate conversations about unnecessary tests, treatments, and procedures. The longstanding tradition of generating a lengthy differential diagnosis as a way of demonstrating medical knowledge has led to students incorrectly assuming that the best way to impress their faculty is to order an exhaustive list of investigations. However, the <\/span>Choosing Wisely medical education lists<\/span><\/a> encourage a more mindful approach, and urge students to consider displaying their knowledge by demonstrating restraint, thinking twice or asking the question “will the result of this test actually change how I manage this patient\u2019s condition?” The lists represent student leadership in driving a <\/span>shift in medical education<\/span><\/a>, where thoroughness is appropriately balanced with thoughtfulness. \u00a0<\/span><\/p>\n

The Canadian Federation of Medical Students (CFMS) and the F\u00e9d\u00e9ration m\u00e9dicale \u00e9tudiante du Qu\u00e9bec (FMEQ) who together represent Canadian medical students surveyed nearly 2000 students to develop the <\/span>first Choosing Wisely medical education list<\/span><\/a>. The Resident Doctors of Canada (RDoC) representing postgraduate medical trainees also released a <\/span>Choosing Wisely list for residents and trainees<\/span><\/a>. Similar initiatives have followed in other countries. For example, the <\/span>New Zealand Medical Students Association recently<\/span><\/a> released a list of six recommendations as part of the country\u2019s Choosing Wisely campaign. Accompanying the list is a mnemonic, WISE<\/a>, which helps students to recall these “key concepts” in medical education, suggesting that prior to ordering tests, treatments, or procedures, students should be reflexive. <\/span><\/p>\n