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AAMC 2014: Choose Wisely: Reducing Medical Waste


How can the field of medicine eliminate waste when students aren’t being trained on the best practices to do so? Vineet Arora, M.D., () tells us about the Teaching Value Choosing Wisely Challenge: a contest that involves everyone from medical students to department chairs in improving patient care at lower costs. 

Arora: Medical trainees do not get education about how to improve value of care for patients, how to reduce costs, and how to choose wisely. One of the things that we want to do is share our best practices.

Announcer: Broadcasting from the Algorithms for Innovation booth at the AAMC in Chicago. The Healthcare Insider is on the Scope, University of Utah Health Sciences Radio.

Interviewer: Crowdsourcing to financiers to reduce health care waste. We're with Vineet Arora. You can find her on Twitter at #futuredocs and were talking about the Teaching Value of Choosing Wisely Challenge, second annual. What problem is this challenge trying to solve?

Arora: So we know that there is over 700 billion dollars in healthcare waste, unnecessary tasks, overtreatment. It's really an epidemic in our healthcare system. And we also know that medical trainees do not get education about how to improve value of care for patients, how to reduce costs, and how to choose wisely.

One of the things that we want to do is share best practices, and unlike regular peer review, traditional peer review literature, we know that sites are doing things and even at this conference there's a lot of interesting things going on. But how are we going to share all those innovations with each other and really implement the best innovations in a timely way, especially given our nation's agenda with the Affordable Care Act.

Instead of doing peer review literature we're using crowdsourcing and asking medical educators, from students all the way to department chairs, deans, faculty, to basically come up with their best ideas, bright ideas or innovations they have already implemented in their institution. Submit to the Challenge so that we can have an expert panel of judges rate those entries and figure out what is going to be the most effective way to do this.

Interviewer: So I would have to believe they there are other places doing this. Why is this a better way?

Arora: We are like the coordinating group. So yeah, there are a lot of people doing this but academic medicine is siloed. Something that might be happening at my place at University of Chicago may not be happening at any of the other places in the city, and we have tons of academic medical centers here. Or it could be different. And so this is a way of accelerating transformation by sharing with each other very quickly what's going on.

We did our first annual challenge last year. We got over 75 entries and all from different parts of the nation from a wide variety of fields. Over 14 specialties represented and we were able to bring to the fore some best practices. One was having a friendly competition. Rob Fogarty from Yale actually has attendings, residents and students all meet together separately to solve a case in a traditional morning report format, but instead of the focus being on what's the disease, it's how to find the diagnosis spending the least amount of money. The students do it first, then the residents do it, then the attendings do it. Interestingly the attendings don't always win. This is a way of changing the culture and having the training environment be thinking about how to promote value. So that's just one example.

Interviewer: How does somebody participate in this challenge, and what's in it for them? Is there a cash prize?

Arora: That's a good question.

Interviewer: Is there a big thumbs up?

Arora: We are all about intrinsic motivation and values so there's no cash prize, but the winners would be convened at the 100th Annual American College of Physicians conference in Boston to give a [inaudible 00:03:28] talk about their experience. And the other thing is you will have an opportunity to be judged by some esteemed folks including Vivian Lee at the University of Utah as well as Daryl Kirch, President of AAMC, and others who are really going to be able to comment on your innovation and perhaps give you some ideas on how to move forward.

This is about creating a movement. A movement of people who are all really invested in doing the same thing. This is really finding other like-minded individuals so you can join our network. We're actually going to launch The Teaching Value Network which is where educators and others can learn from each other throughout the year and showcase the innovations more in-depth through monthly webinars.

Interviewer: So let me get this straight. I'm at an institution. My job in this contest is to go out and find how can I add value?

Arora: Right, and maybe you have already done something but you need a way to share it.

Interviewer: And then I make a video about that?

Arora: Actually, no. All it is, is 500 words on a web site at

Interviewer: All right.

Arora: That's all it is.

Interviewer: And then that's going to be judged?

Arora: That's going to get judged, yep, 500 words.

Interviewer: And if it's good enough, I get to be recognized?

Arora: If it's good enough you get to be recognized, but we recognize everybody. So a great example is even people who didn't "win" the competition last year we invited to go to national meetings. We held regional panels. There was one on the West Coast, one in the Midwest. This is a way to really gain recognition for the work that people are doing in their institution to teach value since we need a way to actually recognize what works best, and if we wait for the peer review traditional literature to come out, we'd be waiting years, and we need to actually do this now.

Interviewer: Yeah. It needs to move faster than that, doesn't it?

Arora: You got it.

Interviewer: So how does somebody participate? Where do they go?

Arora: They can go to our website at and then click on "teaching value" and it has all of our information about our challenge. They just have to put together 500 words. You don't even have to have completed an innovation. You might just have an idea. There's a bright ideas category, and so you can submit a bright idea and that will get judged as well.

Announcer: Sparking conversations to transform academic medicine. For more, stop by our booth at the AAMC or go to, University of Utah Health Sciences Radio.

By: Scot Singpiel

Scot Singpiel is a senior producer for University of Utah's Scope Radio