{"id":40926,"date":"2017-12-20T10:31:19","date_gmt":"2017-12-20T09:31:19","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=40926"},"modified":"2018-01-10T12:52:58","modified_gmt":"2018-01-10T11:52:58","slug":"medical-trainees-should-question-why-they-preemptively-order-routine-tests-and-investigations","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/12\/20\/medical-trainees-should-question-why-they-preemptively-order-routine-tests-and-investigations\/","title":{"rendered":"Medical trainees should question why they preemptively order &#8220;routine&#8221; tests and investigations"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Medical students from around the world utter the Hippocratic Oath when graduating medical school as an age-old commitment to professionalism. Yet, much of what we are taught during medical school conflicts with the oath\u2019s focus on communication and shared-decision making. There is a <\/span><a style=\"background-color: #ffffff;font-size: 1rem\" href=\"https:\/\/jamanetwork.com\/journals\/jama\/article-abstract\/1367571\">hidden curriculum<\/a><span style=\"font-weight: 400\"> in medicine that encourages trainees to do extensive workups to demonstrate their knowledge and curiosity. Choosing Wisely campaigns, in Canada and around the world, are trying to change this and remind trainees that we commit to first doing no harm.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In Canada, the <\/span><a href=\"https:\/\/www.cfms.org\/\"><span style=\"font-weight: 400\">Canadian Federation of Medical Students (CFMS)<\/span><\/a><span style=\"font-weight: 400\"> and <\/span><a href=\"http:\/\/www.fmeq.ca\/en\/\"><span style=\"font-weight: 400\">F\u00e9d\u00e9ration m\u00e9dicale \u00e9tudiante du Qu\u00e9bec (FMEQ)<\/span><\/a><span style=\"font-weight: 400\">, which together represent all medical students in Canada, committed to the campaign by developing a <\/span><a href=\"https:\/\/choosingwiselycanada.org\/students\/\"><span style=\"font-weight: 400\">Choosing Wisely Canada (CWC) list<\/span><\/a><span style=\"font-weight: 400\"> for students and trainees. <\/span><a href=\"http:\/\/journals.lww.com\/academicmedicine\/Citation\/2016\/10000\/Choosing_Wisely_for_Medical_Education___Six_Things.19.aspx\"><span style=\"font-weight: 400\">This list<\/span><\/a><span style=\"font-weight: 400\"> opened up the conversation of resource stewardship, encouraging us to demonstrate our knowledge by thinking twice before ordering a potentially unnecessary test. This evidence-based knowledge tool has provided utility in pre-clerkship case based learning tutorials and clinically in hospital.<\/span><\/p>\n<p><span style=\"font-weight: 400\">As junior housestaff just beginning our clinical training, we are often told the importance of anticipating the staff\u2019s next move and planning appropriately. As such, it becomes normal practice to preemptively order &#8220;routine&#8221; tests and investigations to appease superiors. A striking example of this is the ordering of <\/span><a href=\"https:\/\/choosingwiselycanada.org\/pathology\/\"><span style=\"font-weight: 400\">daily morning complete blood counts for stable patients<\/span><\/a><span style=\"font-weight: 400\"> that exhibit no clinical changes in their course in hospital. This ritualistic ordering of tests is an area where we have been able to utilize the <\/span><a href=\"https:\/\/choosingwiselycanada.org\/students\/\"><span style=\"font-weight: 400\">Choosing Wisely list for students <\/span><\/a><span style=\"font-weight: 400\">to challenge the status quo. When evaluating the clinical utility of a test in this way, we demonstrated critical reasoning that staff always appreciated and deemed appropriate. Nowadays, we often hear colleagues from all levels of training quoting CWC recommendations and soliciting conversations about unnecessary investigations. This feels like a revolution.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Medical students hold a unique position in being both involved in the delivery of healthcare through clinical learning, but also having opportunities through extra-curricular leadership to lead and build momentum on causes of shared importance. The generation of the list of things medical trainees should question introduced students to CWC recommendations and marked the beginning of further student leadership. STARS has helped spur local leadership to <\/span><a href=\"https:\/\/uottawa.scholarsportal.info\/ojs\/index.php\/uojm-jmuo\/article\/view\/1818\/1784\"><span style=\"font-weight: 400\">introduce resource stewardship<\/span><\/a><span style=\"font-weight: 400\"> across medical school curricula.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Each medical school curriculum is unique, and STARS students have helped advocate for local changes throughout the country. For example, at the University of Ottawa, where one of the authors (AM) is a student, a needs-based assessment was conducted amongst pre-clerkship students to determine their knowledge of resource stewardship and assess their perspectives on the subject. A majority of students were not familiar with CWC or its principles, but they appreciated the importance of resource stewardship in practice. A vast majority of students indicated that teaching on the subject should be mandatory. Case-based learning sessions, by enabling thorough small-group discussions about the appropriateness of tests and treatments in given clinical scenarios, were identified as the ideal time within the curriculum to integrate CWC principles.<\/span><\/p>\n<p><span style=\"font-weight: 400\">As students, we see how CWC recommendations can be integrated into the classroom and our clinical rotations, as well as in national student leadership activities. A culture shift is needed, and student commitment is an essential ingredient to solicit change. As the next generation of healthcare providers, we have a responsibility towards the healthcare system in which we will be practising medicine to ensure appropriate use of resources. Our STARS are at the forefront of what will happen next.<\/span><\/p>\n<p>See also:\u00a0<a href=\"https:\/\/blogs.bmj.com\/bmj\/2017\/12\/18\/karen-b-born-et-al-learning-how-to-choose-wisely\/\">Learning how to choose wisely<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><i><span style=\"font-weight: 400\"><strong><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-40927\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/12\/yaeesh_sardiwalla.jpg\" alt=\"\" width=\"150\" height=\"150\" \/>Yaeesh Sardiwalla<\/strong>, BSc is a third-year medical student at Dalhousie University, the Canadian Federation of Medical Student\u2019s national representative to Choosing Wisely Canada and past chair of CWC at Dalhousie. Yaeesh attended the 2015 and presented at the 2017 STARS leadership summit.<\/span><\/i><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><i><span style=\"font-weight: 400\"><strong><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-40928\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/12\/anastasiya.jpg\" alt=\"\" width=\"150\" height=\"150\" \/>Anastasiya Muntyanu<\/strong> is a third year medical student at the University of Ottawa, 2017-2018 Canadian Federation of Medical Student\u2019s national representative to Choosing Wisely Canada, past STARS lead at University of Ottawa. Anastasiya attended the STARS leadership summit in 2015 and presented at the 2017 meeting.<\/span><\/i><\/p>\n<p>&nbsp;<\/p>\n<p><i><span style=\"font-weight: 400\"><strong><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-40929\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/12\/olivier_fortin.jpg\" alt=\"\" width=\"150\" height=\"150\" \/>Olivier Fortin<\/strong>, MD is a first year resident in Pediatric neurology at McGill University and the past F\u00e9d\u00e9ration m\u00e9dicale \u00e9tudiante du Qu\u00e9bec national representative to Choosing Wisely Canada. Olivier presented at the 2017 STARS leadership summit and at the 2017 Preventing Overdiagnosis Conference.<\/span><\/i><\/p>\n<p><strong>Competing interests<\/strong>: None declared.<\/p>\n<p><em><b>Acknowledgements:\u00a0<\/b><span style=\"font-weight: 400\">Thank you to Karen Born for her expertise reviewing this commentary and unwavering support for the STARS community. <\/span><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Medical students from around the world utter the Hippocratic Oath when graduating medical school as an age-old commitment to professionalism. Yet, much of what we are taught during medical school [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2017\/12\/20\/medical-trainees-should-question-why-they-preemptively-order-routine-tests-and-investigations\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":39891,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223,5756],"tags":[],"class_list":["post-40926","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guest-bloggers","category-too-much-medicine"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Medical trainees should question why they preemptively order &quot;routine&quot; tests and investigations - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2017\/12\/20\/medical-trainees-should-question-why-they-preemptively-order-routine-tests-and-investigations\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Medical trainees should question why they preemptively order &quot;routine&quot; tests and investigations - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Medical students from around the world utter the Hippocratic Oath when graduating medical school as an age-old commitment to professionalism. 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