In Reply to Leon-Carlyle and colleagues

The authors articulate the importance of integrating stewardship within the larger medical education curriculum in order to fully realize the goals of the Choosing Wisely campaign. When the ABIM Foundation, Consumer Reports, and nine medical specialty societies launched Choosing Wisely in 2012, we initially envisioned it as an effort to address overuse and waste in the U.S. health care system. We have been inspired to see the campaign and its ideals embraced internationally by our colleagues in Canada, as well as in countries including Australia, the Netherlands, and the United Kingdom. While the goal of Choosing Wisely is simple—to encourage clinicians and patients to engage in conversations about avoiding unnecessary care—achieving it is far more complex. As Leon-Carlyle and colleagues rightly posit, teaching stewardship competencies as part of medical education is a crucial step in ensuring clinicians develop critical thinking skills and are prepared to practice evidence-based medicine when they get to the bedside. To support clinicians in this endeavor, the ABIM Foundation has undertaken several initiatives aimed at catalyzing development of new approaches in medical education and training. In partnership with Costs of Care, the ABIM Foundation launched the Teaching Value in Health Care Learning Network1 to give early adopters and innovators in medical education a venue to share best practices and learnings. The community seeks to inspire others to adapt these ideas and implement them in their own institutions, and a monthly webinar series highlights implementation models and innovations in value-based training. The foundation has also partnered with Costs of Care to run the Teaching Value and Choosing Wisely Challenge,2 which aims to identify promising innovations and bright ideas for teaching high-value care and stewardship to medical students, trainees, and faculty. Over the past two years more than 150 entries have been submitted and a dozen winners declared. Most recently, the ABIM Foundation funded several projects3 that will foster innovations and new approaches to integrating stewardship competencies and better decision making in medical education and training. Much work is still needed until, as the authors write, resource stewardship becomes a “norm in medical practice.” I am encouraged by the growing momentum being generated by the ABIM Foundation’s programs, as well as the work of the authors and many others, to address these challenges and help prepare future clinicians to provide the best care possible for patients. Daniel B. Wolfson, MHSA Executive vice president and chief operating officer, ABIM Foundation, Philadelphia, Pennsylvania; [email protected]

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