On December 5th, the day after the Lown Conference, we will be convening half-day working groups focused on various specific areas for action on reducing overuse. We’ll be posting brief descriptions of each group to help you decide which to attend. If you’re not yet signed up for the conference, register now!
Co-chairs: Dr. Steve Smith and Dr. Leana Wen
Medical education is a crucial driver of overuse. Medical students, residents, and other health professional trainees learn that overuse is an accepted and even expected part of modern medical care. Harms are often minimized and forgotten, and the potential benefits of treatments are over-emphasized.
The Medical Education Working Group has already convened and begun work on understanding the challenge of transforming medical education. They have identified the culture of medicine, particularly its effects on the hidden curriculum, as the critical lever of change on which we must focus our efforts.
This working group meeting will focus on sharing ongoing efforts and developing an action plan moving forward. Specific goals are included in the agenda.
- Recapping the problems with the existing culture of medicine and medical education
- Sharing successes and challenges of existing projects:
- The Do No Harm Project developed by Brandon Combs and Tanner Caverly
- High-value healthcare projects, including Choosing Wisely, discussed by Steve Smith
- Tools medical students and residents to recognize and challenge examples of overuse, being developed by AMSA
- The “social mission in medicine” fellowship being developed by Leana Wen
- Other updates and examples of best practices from the group
- Discussing ways to strengthen and publicize existing projects.
- Discussing other possible projects, for example:
- Mentorship for medical students
- Chapter-based collaborative projects
- A toolkit for med students and residents
- Faculty development
- Educational collaborations with other health professionals, including nurses, PAs, and mental health clinicians.
- Developing a strategy and cohesive work plan that includes strengthening and promoting existing projects and initiating new ideas for practical changes in medical education.
Developing a research agenda
Chair: Adam Elshaug
Understanding the knowledge gaps in research on overuse was a major focus on last year’s Avoiding Avoidable Care conference. Panels there discussed the extent of overuse, its harms, the causes of the problem, and some early efforts to reduce it, but none of those questions had a clear, well-established answer. As researchers and funding organizations focus more on overuse, developing a coherent, policy-relevant research agenda is more important than ever.
The session will include brief opening presentations from chair Adam Elshaug, Vinay Prasad, Michael McWilliams, and Les Levin. The presenters will address where progress has been made in recent years on developing a research agenda, what holes in our understanding have recently emerged, and the status of new efforts to change practice.
The conversation will build on the presentations, with a focus on closing knowledge gaps, fostering policy- and practice-changing research projects, planning and coordinating academic work on overtreatment, overdiagnosis, and the science of health care delivery, and building collaborative relationships that will improve research and dissemination on overuse. It will also be an opportunity to share strategies for funding research, publishing, and talking to colleagues who don’t yet understand the importance of overuse. The working group will conclude with a consensus list of priority research topics, strategies for collaboration, and (hopefully) several new research partnerships.
International collaborations on overuse
Chair: Dr Vikas Saini
The problem of overuse is increasingly recognized as a global one. Major forms of overuse exist in health systems regardless of financing mechanisms or physician compensation models, suggesting that many of the drivers may be complex and may vary regionally. This working group will hear from knowledgeable people from various countries, including India, Brazil, Spain, France, and Germany. The group will explore possible modes of collaboration to foster an international movement within the medical profession, and beyond it to reduce the extent of overuse in health care systems worldwide.
One likely outcome of this group’s work will be the development of a collaborative plan for writing a series of review articles for publication in a major medical journal, in order to provide the first comprehensive review of the problem of overuse in health care systems worldwide. The group will: gather data that quantify overuse around the world; identify the extent to which overuse is attributable to specific payment and delivery systems; identify local customs and cultures that increase or prevent overuse; and identify ways that the common culture of modern scientific medicine drives overuse. The group will also discuss data that are needed to better understand the scope and effects of overuse around the world.
- Brief presentations on the state of overuse across the world
- Paulo Borem (Brazil)
- David Klemperer (Germany)
- Somil Nagpal (India)
- Jean-Claude Salomon (France)
- Jordi Varela (Catalonia, Spain)
- Discussion of areas for further research and collaboration
Choosing Wisely: What happens now?
Chair: Daniel Wolfson
The Choosing Wisely campaign is the most prominent effort to reduce overuse in medicine, and has made important progress in getting specialty societies to recognize that overuse is partly their responsibility. However, the goal of Choosing Wisely is not simply to create checklists of “things to avoid” – it’s to create a medical environment where overuse-awareness and the critical consideration of evidence are the norm, for both patients and clinicians. What structures are in place to help people share successes and challenges in implementing Choosing Wisely, and to harness the momentum generated by the program?
Working group chair Daniel Wolfson will discuss some of the collaborative groups that are already working on expanding CW, including groups focused on medical education, development of the project within medical specialties, implementation in health care systems, and research on implementation strategies. Other representatives from CW partner organizations will also share their experiences with implementation. The main purpose of the working group is to share experiences and best practices, and to inform attendees of opportunities to pursue ongoing Choosing Wisely activities after the conference.
Co-chairs: Marge Ginsburg and Bill Doherty
Reducing overuse is an important goal for improving our health care system, but it is only part of our goal for our public outreach. We intend to create a public discussion of how to achieve the right amount to spend on our healthcare system versus public investment in other social services, such as education and transportation, which have a large impact on our health. Within that discussion, overuse of medical services is a critical starting point. It is an important and harmful symptom of the problems in the existing healthcare system, but it’s also a source of opportunity, as poorly used resources can be otherwise applied to improve the health of individuals, advance public health and strengthen communities.
The public engagement working group will address both strategic and practical questions about developing our public outreach strategy:
- What did we learn from yesterday’s Town Hall exercise? Do you think we captured the reactions people are likely to have in the real world?
- What kinds of groups – Advocacy groups? The general public? Patients with experience of overuse? Community organizations? Others? – do we need to include in public engagement activities? Are there groups that should be excluded?
- What kinds of messages are most compelling in terms of helping people understand the harms of overuse? What kinds of questions do we need the public to answer?
- What else needs to happen before we can organize the first real-world event?
Public engagement can refer to different types of consumer input, from spontaneous gatherings of interested individuals to carefully planned educational and interactive meetings to highly structured deliberative problem-solving discussions. The types of engagement activities we pursue (and encourage others to pursue) may depend on the goals we establish for this Working Group.
Working Group Objectives:
- Identify principles and strategies for engaging the public on the issue of overuse (with an eye toward engaging the public on the larger question of relative investment in healthcare).
- Develop a plan for future collaboration as a working group.
- Welcome and Introductions: Why choose public engagement?
- Sharing experiences with public engagement
- Discussion: Identifying principles and strategies for engaging the public on the issue of overuse.
- Ideas for future collaboration. Who else should be at the table?
- Wrap-Up and Next Steps