Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

Addressing cost of unwarranted medical care in the medical curriculum

David Minh Tran A D and Malcolm P. Forbes A B C

A College of Medicine and Dentistry, James Cook University, Qld 4811, Australia.

B Royal Melbourne Hospital, 300 Grattan Street, Melbourne, Vic. 3050, Australia.

C School of Medicine, University of Queensland, Qld 4006, Australia. Email: MalcolmPForbes@gmail.com

D Corresponding author. Email: david.tran@my.jcu.edu.au

Australian Health Review - https://doi.org/10.1071/AH15172
Submitted: 17 September 2015  Accepted: 7 June 2016   Published online: 29 July 2016

Abstract

Within the past decade, there has been a significant increase in Australia’s health expenditure, with a concurrent rise in overdiagnosis. Australia has introduced the Choosing Wisely campaign in a bid to identify and reduce commonly used investigations, treatments and procedures that add little benefit to patient care. By catalysing a discussion regarding evidence-based use of medications and medical testing, the Choosing Wisely campaign can minimise risk of harm to patients, as well as reduce expenditure. Internationally, several institutions are considering introducing training regarding cost-effective medical investigations into medical school curricula. The American College of Radiology has found positive results when conducting small-group teaching sessions with medical students regarding appropriate imaging modalities. These results are reflected in a US study that used an educational intervention to improve students’ understanding of investigation costs. In addition, the Academy of Clinical Laboratory Physicians and Scientists has developed a proposed curriculum to further medical students’ training in appropriate ordering of laboratory investigations. Australian medical educators must consider whether introducing evidence-based testing into Australian medical curricula should be part of a wider strategy to prevent unnecessary testing and health expenditure now and into the future.


References

[1]  Australian Institute of Health and Welfare (AIHW). Health expenditure Australia 2012–13. Health and welfare expenditure series no. 52. Catalogue no. HWE 61. Canberra: AIHW; 2014.

[2]  Carter SM, Rogers W, Heath I, Degeling C, Doust J, Barratt A. The challenge of overdiagnosis begins with its definition. BMJ 2015; 350 h869
The challenge of overdiagnosis begins with its definition.CrossRef | 1:STN:280:DC%2BC2MnhsVemtA%3D%3D&md5=7f8225253a34ad0f07581b178a62df71CAS | 25740625PubMed | open url image1

[3]  Esserman L, Shieh Y, Thompson I. Rethinking screening for breast cancer and prostate cancer. JAMA 2009; 302 1685–92.
Rethinking screening for breast cancer and prostate cancer.CrossRef | 1:CAS:528:DC%2BD1MXhtlWqs7%2FO&md5=5e7f7b2c39095c1011bb8b5a6a15507aCAS | 19843904PubMed | open url image1

[4]  Schroder FH, Hugosson J, Roobol MJ, Tammela T, Ciatto S, Nelen V, Kwiatowski M, Lujan M, Lilja H, Zappa M, Denis L, Recker F, Berenguer A, Määttänen L, Bangma C, Aus G, Villers A, Rebillard X, van der Kwast T, Blijenberg B, Moss S, de Koning H, Auvinen A. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009; 360 1320–8.
Screening and prostate-cancer mortality in a randomized European study.CrossRef | 19297566PubMed | open url image1

[5]  Bayram C, Britt H, Miller G, Valenti A. Evidence-practice gap in GP pathology test ordering: a comparison of BEACH pathology data and recommended testing. Sydney: University of Sydney, School of Public Health; 2009.

[6]  Bhatia RS, Levinson W, Shortt S, Pendrith C, Fric-Shamji E, Kallewaard M, Peul W, Veillard J, Eishaug A, Forde I, Kerr E. Measuring the effect of Choosing Wisely: an integrated framework to assess campaign impact on low-value care. BMJ Qual Saf 2015; 24 523–31.
Measuring the effect of Choosing Wisely: an integrated framework to assess campaign impact on low-value care.CrossRef | 26092165PubMed | open url image1

[7]  Elshaug AG, Watt AM, Mundy L, Willis CD. Over 150 potentially low-value health care practices: an Australian study. Med J Aust 2012; 197 556–60.
Over 150 potentially low-value health care practices: an Australian study.CrossRef | 23163685PubMed | open url image1

[8]  PerryUndem Research/Communication. Unnecessary tests and procedures in the health care system: what physicians say about the problem, the causes, and the solutions. Results from a national survey of physicians. Washington, DC: PerryUndem Research/Communication; 2014. Available at: www.choosingwisely.org/wp-content/uploads/2015/04/Final-Choosing-Wisely-Survey-Report.pdf [verified 15 September 2015].

[9]  Choosing Wisely Australia. Tests, treatments, and procedures for clinicians and consumers to question. Surry Hills, NSW: NPS MedicineWise; 2015. Available at: http://www.choosingwisely.org.au/recommendations [verified 15 September 2015].

[10]  O’Callaghan G, Meyer H, Elshaug AG. Choosing wisely: the message, messenger and method. Med J Aust 2015; 202 175–7.
Choosing wisely: the message, messenger and method.CrossRef | 25716590PubMed | open url image1

[11]  Kost A, Genao I, Lee JW, Smith SR. Clinical decisions made in primary care clinics before and after Choosing Wisely. J Am Board Fam Med 2015; 28 471–4.
Clinical decisions made in primary care clinics before and after Choosing Wisely.CrossRef | 26152437PubMed | open url image1

[12]  Simos D, Hutton B, Graham ID, Arnaout A, Caudrelier JM, Clemons M. Imaging for metastatic disease in patients with newly diagnosed breast cancer: are doctor’s perceptions in keeping with the guidelines? J Eval Clin Pract 2015; 21 67–73.
Imaging for metastatic disease in patients with newly diagnosed breast cancer: are doctor’s perceptions in keeping with the guidelines?CrossRef | 25311965PubMed | open url image1

[13]  Ramsey SD, Fedorenko C, Chauhan R, McGee R, Lyman G, Kreizenbeck K, Bansal A. Baseline estimates of adherence to American Society of Clinical Oncology/American Board of Internal Medicine Choosing Wisely initiative among patients with cancer enrolled with a large regional commercial health insurer. J Oncol Pract 2015; 11 338–43.
Baseline estimates of adherence to American Society of Clinical Oncology/American Board of Internal Medicine Choosing Wisely initiative among patients with cancer enrolled with a large regional commercial health insurer.CrossRef | 26060225PubMed | open url image1

[14]  Kao AC, Braddock C, Clay M, Elliott D, Epstein SK, Filstead W, Hotze T, May W, Reenan J. Effect of educational interventions and medical school policies on medical students’ attitudes toward pharmaceutical marketing practices: a multi-institutional study. Academic Med 2011; 86 1454–62.
Effect of educational interventions and medical school policies on medical students’ attitudes toward pharmaceutical marketing practices: a multi-institutional study.CrossRef | open url image1

[15]  Stevens DL, King D, Laponis R, Hanley K, Zabar S, Kalet AL, Gillespie C. Medical students retain pain assessment and management skills long after an experiential curriculum: a controlled study. Pain 2009; 145 319–24.
Medical students retain pain assessment and management skills long after an experiential curriculum: a controlled study.CrossRef | 19632781PubMed | open url image1

[16]  Rezaee R, Danaei M, Askarian M. The efficacy of teaching hand hygiene to medical students: an interventional study. Int J Academic Rese Business Social Sci 2014; 4 151–9. open url image1

[17]  Dillon JE, Slanetz PJ. Teaching evidence-based imaging in the radiology clerkship using the ACR appropriateness criteria. Acad Radiol 2010; 17 912–6.
Teaching evidence-based imaging in the radiology clerkship using the ACR appropriateness criteria.CrossRef | 20417133PubMed | open url image1

[18]  Bowman J, Duran A, Duffy B, Gladding S, Baum K. Teaching high-value care: a novel morning report. Clin Teach 2015; 12 165–70.
Teaching high-value care: a novel morning report.CrossRef | 26009950PubMed | open url image1

[19]  McKinney J, Pham L, Chen K, Swaminathan A. The appropriate pathology test study: optimising pathology blood test ordering in the hospital setting. Med Student J Aust 2012; 4
| 1:CAS:528:DC%2BC3sXhsFGrtbzP&md5=e69b3a7f429c9e84d44e1d27ecbd7cfeCAS | open url image1

[20]  Smith BR, Aguero-Rosenfeld M, Anastasi J, Baron B, Berg A, Bock JL, Campbell S, Crookston KP, Fitzgerald R, Fung M, Haspel R, Howe JG, Jhang J, Kamoun M, Koethe S, Krasowski MD, Landry ML, Marques MB, Rinder HM, Roberts W, Schreiber WE, Spitalnik SL, Tormey CA, Wolf P, Wu YY. Academy of Clinical Laboratory Physicians. Educating medical students in laboratory medicine: a proposed curriculum. Am J Clin Pathol 2010; 133 533–42.
Academy of Clinical Laboratory Physicians. Educating medical students in laboratory medicine: a proposed curriculum.CrossRef | 20231605PubMed | open url image1

[21]  Muntz MD, Thapa B, Quirk KL, Thomas JG. Third-year medical students as health value officers: a systematic approach to improving care and reducing costs. MedEdPORTAL Publications. 2015. Available at: https://www.mededportal.org/icollaborative/resource/3929 [verified 17 April 2016].



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