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Medical students release Choosing Wisely list

A list of ‘six things medical students should question’ to help reduce unnecessary care has been released by the two organizations representing Canadian medical students.

The recommendations were released by the Canadian Federation of Medical Students (CFMS) and the Fédération médicale étudiante du Québec (FMEQ) as part of the Choosing Wisely Canada (CWC) campaign to encourage conversations between physicians and patients about potentially unnecessary tests, treatments and procedures, and to help physicians and patients ensure high-quality care.

"As medical students, it is important to learn to practice in a way that is data-driven, evidence-based, and is mindful of limited healthcare resources – but which also assures the highest possible quality of care for our patients and their families,” said Anthea Lafreniere, president of CFMS, in a release.

“This list provides students with a platform to ask tough questions about the role of a test or procedure in the care of their patients.”

The list was developed by a student-led task force with input from nearly 2,000 medical students in Canada.

“This is the first time that students in Canada or anywhere in the world have developed a Choosing Wisely list of recommendations specific to medical education,” said Dr. Wendy Levinson, chair of CWC.

“Choosing Wisely Canada recognizes the importance of medical education in shaping the practices of our future physicians and we’re excited to have the engagement of medical students from across the country in this campaign.”

Canadian Medical Association (CMA) President Cindy Forbes said the student-led initiative shows the commitment of Canada’s future physicians to supporting the delivery of appropriate care. The CMA is a strong supporter and sponsor of CWC.

Dr. Jessica Otte, a family physician in Nunavut and Vancouver Island, publishes a blog called ‘Less is More Medicine’ dedicated to reducing unnecessary care.

In a recent post, she applauded the medical students for developing the list and noted it was important for several reasons, including recognizing the professionalism, critical-thinking and ethical intelligence of young clinicians.

“Each of the items is patient-centred at a high-level; the list ensures that the goals of the patient – not the learner – are paramount, and that the learner will advocate in this regard,” she added.

The medical student list includes the following recommendations:

  • Don’t suggest ordering the most invasive test before considering other less invasive options.
  • Don’t suggest a test, treatment, or procedure that will not change the patient’s clinical course.
  • Don’t hesitate to ask for clarification on tests, treatments, or procedures that you believe may be ordered inappropriately.
  • Don’t miss the opportunity to initiate conversations with patients about whether a test, treatment or procedure is necessary.
  • Don’t suggest ordering tests or performing procedures for the sole purpose of gaining personal clinical experience.
  • Don’t suggest ordering tests or treatments pre-emptively for the sole purpose of anticipating what your supervisor would want.

The new list brings to more than 160 the number of recommendations about tests and procedures that medical organizations say are overused and inappropriate and that should discussed by physicians and patients before ordering.

Forward any comments about this article to: cmanews@cma.ca.