After receiving feedback from my peers, I have added some finer details to my educational dilemma. Some of the suggestions included providing more evidence to back up my statement that this tool was necessary for family medicine residents. I refined the exact module that I hope to utilize to convey the message. There was some confusion regarding when students would engage with my tool, so I tried to specify this further. I added in some sources to the outline of the dilemma, so feel free to check out the references. I hope you all enjoy my Revised Educational Dilemma and I look forward to more comments!
Background:
Can you believe that 30% of tests, treatments, and procedures in our health care system are unnecessary?1 Choosing Wisely Canada is one of the solutions to this crisis, and I am truly passionate about this cause which benefits patients and the health system as a whole. I have an interest in teaching residents how to become better clinicians. As a family medicine resident and a future care of the elderly fellow, I am keenly aware of the gaps in training particularly in care of older adults. Studies have shown that family medicine residents are unprepared for care of the elderly and there are weaknesses in delivering geriatric training2.
The Tool:
Choosing Wisely Canada and the Canadian Geriatrics Society has created a list of “Five Things Physicians and Patients Should Question”3. I hope to create a module that can deliver this message to residents. I will use powerful anecdotes to teach residents about these recommendations. After looking into different options, I have decided to start with a pilot iteration where I deliver the module using a Powtoon video and include multiple choice questions. This will effectively engage residents and turn this tool from passive to active learning. As a final product with a more robust budget, I hope to work with a new graduate, potentially from the Biomedical Communications program at the University of Toronto to create an interactive tool. This module will be similar to the PGCorEd modules that Postgraduate Medicine hosts at the University of Toronto4.
The Audience:
The users of this module will be family medicine residents who are about to start their geriatrics rotations in first year residency. I will first pilot this module at my local site at Mount Sinai Hospital before expanding it to the entire Department of Family and Community Medicine. The reason a video module is needed is because it creates an interactive form of learning that would otherwise not be taught well in written form. The helpful anecdotes can be illustrated to appease the visual learner and make the lessons more memorable. This would be mandatory pre work that would be done before their rotation and would only take 15 minutes to complete. Interactive workshops have been shown to improve knowledge of resource stewardship and a video module can provide a similar online experience5. The ultimate goal is to increase the confidence of family medicine residents better and to make the residents better clinicians, particularly when caring for older adults.
References:
1. Blomqvist A, Busby C. The Paradox of Productivity, Technology, and Innovation in Canadian Healthcare. CD Howe Institute Commentary. 2017 May 23;480.
2. Ingram E, Dunkley O, Willoughby K, Yaffe M, Rodríguez C. Assessing Family Medicine Residents’ Preparedness for the Practice of Geriatric Care. PRiMER. 2019;3.
3. Canadian Geriatrics Society [Internet]. Choosing Wisely Canada 2019. Five Things Physicians and Patients Should Question. [cited 4 Feb 2019]. Available from: https://choosingwiselycanada.org/geriatrics/
4. Law M. The Role of Technology in Medical Education: Lessons from the University of Toronto. UTMJ.:150.
5. Mukerji G, Weinerman A, Schwartz S, Atkinson A, Stroud L, Wong BM. Communicating wisely: teaching residents to communicate effectively with patients and caregivers about unnecessary tests. BMC medical education. 2017 Dec;17(1):248.
Canadian Geriatrics Society Choosing Wisely Canada Recommendations 
Hi Elliot-thanks for adding these details, I think it makes your dilemma/pitch even stronger.
Have you thought about how you’re going to evaluate the impact of this video (eg. survey residents who use it, or in another way)?
Cheers
Katie
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Thanks so much Katie for the kind words.
I think evaluation is a very important part of this initiative and not included in my explanation of the dilemma. I agree that a survey would be insightful that compares the residents at Sinai who receive the intervention to see how the resident experiences and comfort levels differ to those that don’t. I could focus the Likert questions to resource stewardship and elderly care in general. I could also take it a step further and somehow analyze practice patterns of the residents, if I can obtain the resident ordering practices of tests, treatments, and procedures through an EMR analysis. If there is a difference, this could be a good argument for expansion. If expanded, we would need to evaluate iteratively to ensure that the module is sustainable and meets the needs of all family medicine residents. If I get research ethics board approval, this could make for a nice academic project.
I will keep you posted!
Thanks,
Elliot
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Hi Elliot!
Great Idea! I think this is going to be very useful! I am a resident who loves videos.
I am wondering if a good tool would be to randomize half the residents to the video/teaching and the other to none and see if there is a difference between their practice. Maybe have a case scenario with questions like “which labs would you order for this patient” and have them complete 1 month after you disseminate the video?
Michael
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Hey Michael!
Thanks for the great feedback. Evaluation is one area that I will need to strongly consider. It will need to be done in a very evidence based way and I will need to find away to minimize any potential confounding variables. I think having a group that gets exposed to the intervention and having one that does not is a good way to go by running this study. I will need to control for other things like types of exposure in the rotation so maybe even comparing one block where Sinai residents get the intervention and the next where they don’t watch the video. I think having a retention quiz would be very helpful. Retention tests with have been helpful for learning and assessment in medical education. See this article that goes into more in depth about the process in the context of clinical skills and simulation training with deliberate practice improving the retention test scores.
https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-019-1663-2
Thanks again for the feedback!
Elliot
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