An Educational Forum to Engage Infectious Diseases and Microbiology Residents in Resource Stewardship Modelled after the Choosing Wisely Campaign
Bibliographic record
Abstract
BACKGROUND: Rising costs present a major threat to the sustainability of health care delivery. Resource stewardship is increasingly becoming an expected competency of physicians. The Choosing Wisely framework was used to introduce resource stewardship at a national educational retreat for infectious disease and microbiology residents. METHODS: During the 2014 Annual Canadian Infectious Disease and Microbiology Resident Retreat in Toronto, Ontario, infectious disease (n=50) and microbiology (n=17) residents representing 11 Canadian universities from six provinces, were invited to participate in a modified Delphi panel. Participants were asked, in advance of the retreat, to submit up to five practices that infectious disease and microbiology specialists should not routinely perform due to lack of proven benefit(s) and/or potential harm to patients. Submissions were discussed in small and large group forums using an iterative approach involving electronic polling until consensus was reached for five practices. A finalized list was created for both educational purposes and for residents to consider enacting; however, it was not intended to replace formal society-endorsed statements. A follow-up survey at two-months was conducted. RESULTS: Consensus was reached by the residents regarding five low-value practices within the purview of infectious diseases and microbiology physicians. After the retreat, 20 participants (32%) completed the follow-up survey. The majority of respondents (75%) believed that the session was at least as relevant as other sessions they attended at the retreat, including 95% indicating that at least some of the material discussed was new to them. Since returning to their home institutions, nine (45%) respondents have incorporated what they learned into their daily practice; four (20%) reported that they have considered initiating a project related to the session; and one (5%) reported having initiated a project. CONCLUSIONS: The present educational forum demonstrated that trainees can become actively engaged in the identification and discussion of low-value practices. Embedding residence training programs with resource stewardship education will be necessary to improve the value of care offered by the future members of our profession.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.025 | 0.031 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.009 | 0.004 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.003 | 0.010 |
| Research integrity | 0.004 | 0.005 |
| Insufficient payload (model declined to judge) | 0.016 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".