THE PAEDIATRICIAN AS A LEADER: AN EDUCATIONAL INTERVENTION FOR HIGH-VALUE CARE

Abstract BACKGROUND The CanMEDS framework for physician competency defines necessary competencies of medical practice, laying the foundation for medical education and subsequent practice in Canada to meet patient needs. The role of Leader highlights the importance of quality improvement, stewardship, health care resource allocation and ability to apply evidence and management processes to facilitate cost-appropriate care. Educational innovations in this domain have not previously been described. OBJECTIVES To evaluate the impact of an educational intervention developed to foster stewardship of health care resources for paediatricians in training. DESIGN/METHODS An educational workshop on high-value care was created for general paediatric residents. Prior to workshop development, the study team procured local costing information from microbiology, general chemistry/laboratory, pharmacy, and radiology. During the workshop, individual, small group and interactive activities were used to explore clinical decision making and associated costs, radiation dosing, and non-monetary implications of care. A pocket-card reference was developed for use during the exercises. To assess the impact of the workshop, participants completed a post-workshop reflection asking them to identify lessons learned and an action plan for providing high-value care. Qualitative exploration of statements was conducted using thematic analysis; individual responses were coded and grouped into three overarching themes for both lessons learned and action plan. RESULTS Forty-three learners participated in the workshop. Post-workshop reflections yielded 93 lessons learned statements, and 67 action plan statements. Lessons learned were grouped into three themes: Scope, Content and Judgement Statements. Within Scope, most statements were general (80%) versus specific. Content areas most frequently cited included cost (61%), diagnostic imaging (28%) including radiation exposure (14%), and non-monetary costs of care (17%). Inferences about aspects of learnings, such as those referring to expense, value or waste, were labelled as Judgement Statements, and were present in 50% of the responses. Action plan statements were grouped into themes of Scope, Content and Action Words. Responses were again generally focused (87%). Most frequent Content subtheme responses were: tests (37%), non-monetary costs of care (21%), and diagnostic imaging (12%). Action words were grouped into seven categories as depicted in Figure 1, with Consider as most frequent (46%). CONCLUSION Reflections on non-monetary costs and action plans that consider how investigations might change management seemed to resonate with our single centre paediatric trainees. Longitudinal follow-up may help identify most impactful components of this educational workshop.

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