Family medicine residents have many competing pressures, whether it be from their supervisors or their patients. The first step to Choosing Wisely comes from understanding what is preventing you from Choosing Wisely in the first place.
My Final Assignment
It was a pleasure working on this final assignment to help create an online module for family medicine residents to become better clinicians when caring for older adults.
Below you will find the link to my website which includes the quizzes and modules for Choosing Wisely Canada.
Enjoy!
Final Elevator Pitch
After getting lots of great feedback from my peers and instructors, I present to you my Final Elevator Pitch. It is titled Teaching the Choosing Wisely Canada Geriatrics Recommendations. It was fascinating learning about PowToon and how to integrate the audio and visuals together. I learned a lot of important lessons that I hope to build on for when I make my final project. My final project will be an interventional video tool explaining these recommendations in more depth for family medicine residents. It was my first time uploading anything to YouTube and I can truly say that the process was seamless.
Enjoy!
Revised Educational Dilemma
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.
My Elevator Pitch
The Problem:
Did you know that up to 30 per cent of medical care is unnecessary in Canada?
Medical overuse costs the health care system millions of dollars and our patients unnecessary interventions resulting in adverse events.
This disproportionately impacts elderly patients.
The Solution:
Choosing Wisely Canada is the national voice in reducing unnecessary tests, treatments, and procedures in health care.
Family medicine residents can have a reduced comfort when treating older adults and therefore not practice optimal resource stewardship.
The Tool:
An instructional video can teach family medicine residents about the Canadian Geriatrics Society recommendations.
An example of a recommendation is to not use sedative-hypnotics for insomnia in the elderly.
The Goal:
The video module can help family medicine residents gain comfort with choosing wisely and ultimately become better clinicians when caring for older adults.
The Geriatric Population
Older patients are unique in many ways. There is a wide spectrum of patients who can be high functioning or quite frail. How does the patient’s functional impairment impact your decision making for ordering tests, treatments, and procedures? If there is cognitive impairment and the history is therefore not as robust, a provider may order more testing than if the patient was fully competent. Have you come across this issue in your practice? What are some ways that you still work to use resources judiciously for these patients?
The next question to ask are what are the possible solutions to how to better Choose more Wisely with your geriatric patients?
Do we need educational tools for patients or for residents? Or should the message be geared towards staff doctors? Are there any special tools we can use to help with communicating Choosing Wisely? Ultimately, the answer is likely multifactorial. Getting around these barriers listed above CAN be accomplished!
