Implementation of Choosing Wisely in gynecology and obstetrics internship

Authors

DOI:

https://doi.org/10.17267/2594-7907ijeh.2024.e5579

Keywords:

Internship, Gynecology, Obstetrics, Education Medical

Abstract

INTRODUCTION: Throughout undergraduate school, it is important to instill a continuous emphasis on cost-conscious thinking across all specialties, including obstetrics and gynecology (OB/GYN). One potential strategy is the implementation of the Choosing Wisely (CW) Campaign. OBJECTIVE: To describe and assess the implementation strategies of the Choosing Wisely (CW) campaign within a medical internship in Obstetrics and Gynecology (OB/GYN). METHODS: This intervention study involved medical teachers and undergraduate medical students at a Brazilian medical school. Initially, teachers identified three common unnecessary clinical scenarios, which were then grouped and adapted to fit the CW recommendation format. Based on the five most frequently occurring recommendations, educational activities were developed, including workshops, banners, and discussions on cost-consciousness in healthcare with undergraduate students and medical doctors. RESULTS: The top five recommendations were as follows: 1. Don’t routinely order hormone levels for menopause diagnosis; 2. Don’t recommend ovarian removal during hysterectomy for premenopausal women without ovarian câncer risk; 3. Don’t prescribe broad-spectrum antibiotics for uncomplicated acute cystitis treatment; 4. Don’t request preventive examinations for colpitis diagnosis; and 5. Don’t request unnecessary exams during low-risk prenatal care, such as kidney and liver function tests. The theoretical and practical components of these educational activities led to increased awareness and subsequent discussions among internship faculty and undergraduate students. CONCLUSION: Implementation of the CW campaign within the medical internship in OB/GYN resulted in a positive impact, fostering reflection among participants and aiding in the avoidance of unnecessary treatments or prescriptions.

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References

(1) Greenberg J, Green JB. Over-testing: why more is not better. Am J Med. 2014;127:362-363. https://doi.org/10.1016/j.amjmed.2013.10.024

(2) Papanicolas I, Woskie LR, Jha AK. Health Care Spending in the United States and Other High-Income Countries. JAMA. 2018;319(10):1024–1039. https://doi.org/10.1001/jama.2018.1150

(3) Kliff S. We spend $750 billion on unnecessary health care. Two charts explain why [Internet]. The Washington Post. 2012 sept. 7. Available from: https://www.washingtonpost.com/news/wonk/wp/2012/09/07/we-spend-750-billion-on-unnecessary-health-care-two-charts-explain-why/

(4) Lara NC, Campino A, Carneiro LA. Evidências de práticas fraudulentas em sistemas de saúde internacionais e no Brasil. Instituto de Estudos de Saúde Suplementar; 2017. Available from: https://www.iess.org.br/biblioteca/tds-e-estudos/textos-para-discussao/td-62-evidencias-de-praticas-fraudulentas-em

(5) Young PL, Olsen LA. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington: The national academic press; 2010. Available from: http://www.nap.edu/catalog/12750.html

(6) Cassel CK, Guest JA. Choosing Wisely. JAMA. 2012;307(17):1801-2. https://doi.org/10.1001/jama.2012.476

(7) The American College of Obstetricians and Gynecologists. Choosing Wisely. 2013; Available from: https://www.acog.org/practice-management/patient-safety-and-quality/partnerships/choosing-wisely

(8) Proqualis. Aprimorando as Práticas de Saúde [Internet]. Available from: https://proqualis.net/choosing-wisely-brasil

(9) Linstone HA, Turoff M. The Delphi Method - Techniques and Applications. 2002. Available from: https://www.foresight.pl/assets/downloads/publications/Turoff_Linstone.pdf

(10) Bermudes WL, Santana BT, Braga JHO, Souza PH. Tipos de escalas utilizadas em pesquisas e suas aplicações. Vértices. 2016;18(2):7-20. Available from: https://editoraessentia.iff.edu.br/index.php/vertices/article/view/1809-2667.v18n216-01

(11) Phillips AC, Lewis LK, McEvoy MP, Galipeau J, Glasziou P, Moher D, Tilson JK, Williams MT. Development and validation of the guideline for reporting evidence-based practice educational interventions and teaching (GREET). BMC Med Educ. 2016;16(1):237. https://doi.org/10.1186/s12909-016-0759-1

(12) Levinson W, Kallewaard M, Bhatia RS, Wolfson D, Shortt S, Kerr E a. “Choosing Wisely”: a growing international campaign. BMJ Qual Saf. 2015;24(2):167-174. https://doi.org/10.1136/bmjqs-2014-003821

(13) Davies M, Sarri G, Lumsden MA. Diagnosis of the menopause: National Institute for Health and Care Excellence (NICE). Menopause Quality Standard Contents Contents. Annals of Clinical Biochemistry. 2017, 54(5):516–518. https://doi.org/10.1001/jamainternmed.2016.2761

(14) Ministério da Saúde (Brazil). Manual de atenção à mulher no climatério/menopausa. Brasília: Ministério da Saúde; 2008. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/manual_atencao_mulher_climaterio.pdf

(15) Lumsden MA. The NICE Guideline – Menopause: diagnosis and management. Climacteric. 2016;19(5):426-429. https://doi.org/10.1080/13697137.2016.1222483

(16) Plusquin C, Fastrez M, Vandromme J, Rozenberg, S. Determinants of the decision to perform prophylactic oophorectomy in association with a hysterectomy for a benign condition. Maturitas. 2012;73(2):164-166. https://doi.org/10.1016/j.maturitas.2012.06.014

(17) Orozco LJ, Tristan M, Vreugdenhil MMT, Salazar A. Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women. Cochrane Database Syst Rev. 2014;2014(7). https://doi.org/10.1002/14651858.CD005638.pub3

(18) Marques AR, Cunha, AF. Infecções urinárias não complicadas na mulher: esperar ou tratar? Rev Port Med Geral Fam. 2016;32(4):280-2. Availabre from: https://rpmgf.pt/ojs/index.php/rpmgf/article/view/11830

(19) Hooton TM. Uncomplicated Urinary Tract Infection. New Engl J Med. 2012;366(11):1028-37. https://doi.org/10.1056/NEJMcp1104429

(20) Miranda EJP, Oliveira GSS, Roque FL, Santos SR, Olmos RD, Lotufo PA. Susceptibility To Antibiotics in Urinary Tract Infections in a Secondary Care Setting From 2005-2006 and 2010-2011, in São Paulo, Brazil: Data From 11,943 Urine Cultures. Rev Inst Med Trop Sao Paulo. 2014;56(4):313-324. https://doi.org/10.1590/S0036-46652014000400009

(21) Meireles-Flores AL, Walker JN, Caparon M, Hultgren. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13(5):269–84. https://doi.org/10.1038/nrmicro3432

(22) Pinho AA, França-Junior I. Cervical cancer prevention: a theoretical framework to analyze Papanicolaou test access and use. Rev bras saúde Matern infant. 2003;3(1):95-112. https://doi.org/10.1590/S1519-38292003000100012

(23) Storti-Filho A, Svidizinski TIE, Souza RJDS, De Mello ICJ, Souza PDC, Consolaro MEL. Oncotic colpocytology stained with Harris-Shorr in the observation of vaginal microorganisms. Diagnostic Cytopathology. 2008;36(6):358-62. https://doi.org/10.1002/dc.20820

(24) McMillan A. The detection of genital tract infection by Papanicolaou-stained tests. Cytopathology. 2006;17:317-22. https://doi.org/10.1111/j.1365-2303.2006.00411.x

(25) Chiuchetta GIR, Ruggeri LR, Piva S, Consolaro MEL. Estudo das inflamações e infecções cérvico-vaginais diagnosticadas pela citologia. Arq Ciência Saúde Unipar. 2002:6(2):123-28. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/lil-350969.

(26) Ministério da Saúde (Brazil). Protocolos Da Atenção Básica - Saúde Das Mulheres. Brasília: Instituto Sírio-Libanês de Ensino e Pesquisa; 2016. Availabe from: http://bvsms.saude.gov.br/bvs/publicacoes/protocolos_atencao_basica_saude_mulheres.pdf

(27) Peixoto S, Duarte G, Madi JM. Manual de Assistência Pré-Natal. 2a edição. São Paulo: Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO); 2014.

(28) Gohel MG, Joshi AG, Anand JS, Makadia JS, Kamariya CP. Evaluation of changes in liver function test in first, second and third trimester of normal pregnancy. Int J Reprod Contracept Obs Gynecol. 2013;22(4):616-20. https://doi.org/10.5455/2320-1770.ijrcog20131225

(29) Ministério da Saúde (Brazil). Caderno de Atenção Ao Pré-Natal de Baixo Risco. Brasília: Secretaria de Atenção à Saúde; Departamento de Atenção Básica; 2012. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/cadernos_atencao_basica_32_prenatal.pdf

(30) Domingues RMSM, Hartz ZMA, Dias MAB, Leal MC. Adequacy of prenatal care in the National Health System in the city of Rio de Janeiro, Brazil. Cad Saúde Pública. 2012; 28(3):425-37. https://doi.org/10.1590/S0102-311X2012000300003

(31) Muntyanu A, Jebanesan D, Kuling P. Choosing Wisely: Resource Stewardship Education in Canadian Medical Schools. UOJM ePub; 2017. Available from: https://www.researchgate.net/publication/313454229_Choosing_Wisely_Resource_Stewardship_Education_in_Canadian_Medical_Schools/fulltext/589b20dfaca2721f0db5eae1/Choosing-Wisely-Resource-Stewardship-Education-in-Canadian-Medical-Schools.pdf

(32) Lakhani A, Lass E, Silverstein WK, Born KB, Levinson W, Wong BM. Choosing wisely for medical education: Six things medical students and trainees should question. Acad Med. 2016;(91):1374-78. https://doi.org/10.1097/ACM.0000000000001325

(33) Cardone F, Cheung D, Han A, Born KB, Alexander L, Levinson W, et al. Choosing Wisely Canada Students and Trainees Advocating for Resource Stewardship (STARS) campaign: a descriptive evaluation. CMAJ OPEN. 2017:5(4):864-70. https://doi.org/10.9778/cmajo.20170090

(34) Post J, Reed D, Halvorsen AJ, Huddleston J, McDonald F. Teaching High-value, Cost-conscious Care: Improving Residents’ Knowledge and Attitudes. Alliance for Academic Internal Medicine. 2013;126(9):838-42. https://doi.org/10.1016/j.amjmed.2013.05.015

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Published

07/17/2024

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Original Articles

How to Cite

1.
Mendonça DR, Brito MB, Aguiar CVN, Lins-Kusterer L, Scavuzzi ACF, Menezes MS. Implementation of Choosing Wisely in gynecology and obstetrics internship. Intern J Educ H [Internet]. 2024 Jul. 17 [cited 2024 Jul. 22];8:e5579. Available from: https://www5.bahiana.edu.br/index.php/educacao/article/view/5579

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