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Choosing Wisely Canada has engaged with Medical Students and Residents on the topic of starting conversations around unnecessary tests, treatments, and procedures

Cases & Clinical Vignettes:

The Do No Harm Project: Website created by The University of Colorado School of Medicine

  • The goal of the Do No Harm Project is to use clinical vignettes written by trainees to improve recognition of harms that may result from medical overuse and to drive a needed culture change in the practice of medicine. 
  • A series in JAMA Internal Medicine called “Teachable Moments” launched September 2013 as a result of this work

Online, Interactive High Value Care Cases: From the American College of Physicians (ACP) [requires ACP login]

  • Learn how to eliminate unnecessary health care costs and improve patient outcomes while earning free CME credits
  • 30- to 60-minute online interactive HVC cases, include learning to:
    • Avoid Unnecessary Testing
    • Use Emergency and Hospital Level Care Judiciously
    • Improve Outcomes with Health Promotion and Disease Prevention
    • Prescribe Medications Safely and Cost Effectively
    • Overcome Barriers to High Value Care

Online discussion:

NEJM Resident 360: Care, Cost, and Choice: How to deliver high-value care

  • A time-limited online discussion between residents on the front lines of care, that aims to explore the questions of: 

    • What is high-value care? 
    • What are some tips to think about the tests and treatments that patients don’t  need, rather than only what they do need?
    • What resources are available to learn more about the costs and value of health care?
    • How can I begin a project at my hospital around high-value care?


Teaching Value in Health Care: Google+ Group created by ABIM Foundation [private, must request membership]

  • "Here you will find resources to help—didactic modules, experiential techniques, systems-level strategies, and the wisdom and creativity of fellow trail-blazers seeking to re-shape clinical learning environments toward high-value patient care. "

Students4Best Evidence: Website

  • A network for students interested in evidence-based healthcare
  • Reviews written by students of evidence-based resources; including slideshows, lectures, websites, online courses and databases
  • Facebook page – www.facebook.com/Students4BE
  • Twitter handle – @Students4BE

Online courses/modules:

*NEW* CanMEDS Resource Stewardship Curriculum Toolkit Series - Royal College of Physicians and Surgeons of Canada

  • As leaders in the health care system, physicians regularly engage in the stewardship of health care resources. In a complex system with competing priorities and demands, resource stewardship is often challenging. Fortunately, the competencies required for good stewardship can be learned and with the introduction of CanMEDS 2015, these competencies will soon be a part of every trainee’s toolkit.
  • There are  Three Toolkits, each containing a powerpoint and a preceptor guide:
    • Foundations - basic information, vocabulary to facilitate residents becoming mindful of considering the (broad) harms and benefits of any test, treatment, or procedure.
    • Projects - information and guidance on how to undertake a scholarly (eg. research or QI) project in this area
    • Communication - scenarios, role play, and other resources to help residents communicate with patients and families who may request an unnecessary test, treatment, or procedure

Confronting Unnecessary Care: Created by Choosing Wisely Canada with a grant from the Canadian Medical Association. 

  • This module reviews the issue of unnecessary care in Canada and describes the resources and clinical guidance available through Choosing Wisely Canada – a physician-initiated campaign that encourages physicians and patients to have evidence-informed conversations about the necessity of medical tests and treatments so as to eliminate unnecessary care.

Discovering Value-Based Health Care Interactive Learning Modules from Dell Medical School, at The University of Texas at Austin

  • Create a free login to access 3 Modules on Value-Based Health Care:

      "This module defines the goals of value-based health care. . . we help break down and identify the most common areas of inefficiency and wasteful practices present in health care, providing you with a foundation to understand from where issues stem. This understanding is necessary to achieve change and to guarantee value provision in health care."


      "In this module, you will explore how to elicit and measure outcomes that matter to patients. We will discuss how to incorporate patient goals, priorities, desires, and experiences. These are true measures of success, and learning to account for and base patient care around the whole patient--not just his or her symptoms--will be true indicators of creating value."


      "In this module, you will learn how costs are assessed and broken down as well as various methods and strategies in cost assessment and physician reimbursement. You will also determine which methods provide the most transparency and most patient value. Through gaining an understanding of and ability to discuss health care costs, you will be armed to provide clarity to your patients and to help rein in the waste that is such a large part of our current system."

High Value Care Course: A collaboration between MedU, the American College of Physicians (ACP), and the Alliance for Academic Internal Medicine (AAIM) [requires Med-U course subscription] 

  • Medical students must understand how their decisions about diagnostic testing, care management, and other interventions affect the costs and efficacy of care. 
  • These twelve innovative online, cross-discipline, case-based modules have been adapted from the ACP-AAIM’s HVC Resident Curriculum to begin teaching the fundamentals of value in healthcare to medical students and all health care professionals.
  • The modules include short interactive virtual patient cases, brief instructional videos, key teaching points, and embedded links so that students can apply principles from the HVC modules to other cases.

QCV 100: An Introduction to Quality, Cost, and Value in Health Care: Part of the Instituted for Health Care Improvement (IHI)'s Open School [requires paid or institutional subscription]

  • "This course will provide you with an overview of value in health care. We’ll start by distinguishing between cost and value, and understanding how both of these concepts relate to quality. We’ll introduce you to the growing problem of health care spending, as well as the health care practitioner’s role in managing these costs. Finally, we’ll explain how to identify and overcome barriers to providing high-value, cost-effective care."

Overdiagnosis Module: From Royal College of General Practicioners (RCGP) eLearning [requires login, free]

  • Overdiagnosis occurs when asymptomatic people are diagnosed with a disease that will not cause them to experience symptoms or early death. A broader definition encompasses the related problems of overmedicalisation and subsequent overtreatment, diagnosis creep, shifting thresholds and disease mongering
  • This module will discuss the issues around overdiagnosis with examples from the fields of cancer and cardiovascular risk factors.

Decision Aids 101 (subscription required) has created a toolkit to give managers the resources they need to help frontline clinicians incorporate patient input into care decisions, i.e. to do shared decision

Transfusion Medicine for Physicians online Course "Blood Transfusion: Less is More": Created by the BC Provincial Blood Coordinating Office

  • This one hour online course, aligned with Choosing Wisely Canada, consists of six 10-minute modules with accompanying references and resources to update and test practice knowledge in transfusion medicine. Modules may be completed at any time in any order, and may be completed at one or multiple sittings.




Prostate cancer: In this video, Hans Rosling briefly reviews the risk of getting diagnosed with, and the risk of dying from, prostate cancer in the world. His visual presentation of statistics encourages us to consider overdiagnosis as a contributor to the rising number of cases diagnosed.