群体的智慧：教学价值中的明智想法与创新以及明智选择挑战

Wisdom of the crowd: bright ideas and innovations from the teaching value and choosing wisely challenge.

作者信息

Shah Neel, Levy Andrew E, Moriates Christopher, Arora Vineet M

机构信息

N. Shah is founder and executive director, Costs of Care, Inc., and assistant professor of obstetrics, gynecology, and reproductive biology, Harvard Medical School, Boston, Massachusetts. A.E. Levy is resident advisor, Teaching Value Project, Costs of Care, Inc., Boston, Massachusetts, and resident in internal medicine, The University of Chicago Medical Center, Chicago, Illinois. C. Moriates is director of implementation initiatives, Costs of Care, Inc., Boston, Massachusetts, and assistant professor of medicine, University of California, San Francisco, San Francisco, California. V.M. Arora is director of education initiatives, Costs of Care, Inc., Boston, Massachusetts, and associate professor of medicine and director, Graduate Medical Education Clinical Learning Environment Innovation, The University of Chicago, Chicago, Illinois.

出版信息

Acad Med. 2015 May;90(5):624-8. doi: 10.1097/ACM.0000000000000631.

DOI:10.1097/ACM.0000000000000631

PMID:25565262

Abstract

PROBLEM

Medical education has been cited as both part of the problems facing, and part of the solution to reforming, the increasingly challenging U.S. health care system which is fraught with concerns regarding the quality and affordability of care. To teach value in ways that are impactful, sustainable, and scalable, the best and brightest ideas need to be shared such that educators can build on successful existing innovations.

APPROACH

To identify the most promising innovations and bright ideas for teaching value to clinical trainees, the authors hosted the "Teaching Value and Choosing Wisely Challenge." The challenge used crowdsourcing methods to solicit scalable, pedagogical approaches from across North America, and then draw generalizable lessons.

OUTCOMES

The authors received 74 submissions (28 innovations; 46 bright ideas) from 14 students, 20 residents/fellows, 38 faculty members (ranging from instructors to full professors), and 2 nonclinical administrators. Submissions represented 14 clinical disciplines including internal medicine, emergency medicine, surgery, pediatrics, obstetrics-gynecology, laboratory medicine, and pharmacy. Thirty-nine abstracts focused on graduate medical education, 15 addressed undergraduate medical education, and 20 applied to both.

NEXT STEPS

The authors have solicited, shared, and described solutions for teaching high-value care to medical trainees. Challenge participants demonstrated commitment to improving value and ingenuity in addressing professional barriers to change. Further success requires strong local faculty champions and willing trainee participants. Additionally, the use of data to demonstrate the collective positive impact of these ideas and programs will be critical for sustaining pedagogical changes in the health professions.

摘要

问题

医学教育既被认为是日益具有挑战性的美国医疗保健系统所面临问题的一部分，也是该系统改革解决方案的一部分。美国医疗保健系统在医疗质量和可负担性方面存在诸多问题。为了以有影响力、可持续且可扩展的方式传授价值观，需要分享最佳和最具创新性的想法，以便教育工作者能够在现有的成功创新基础上进行拓展。

方法

为了确定向临床实习生传授价值观最具前景的创新和优秀想法，作者举办了“传授价值观与明智选择挑战”活动。该挑战采用众包方法，从北美各地征集可扩展的教学方法，然后总结出可推广的经验教训。

成果

作者收到了来自14名学生、20名住院医师/研究员、38名教员（从讲师到正教授）和2名非临床管理人员的74份提交材料（28项创新；46个优秀想法）。提交材料涵盖14个临床学科，包括内科、急诊医学、外科、儿科、妇产科、检验医学和药学。39篇摘要聚焦于毕业后医学教育，15篇涉及本科医学教育，20篇适用于两者。