Session 1
This section contains all of the suggested discussion questions for class meetings.
SESSION 1:
  • (10’) Welcome Back
      • Opener: Reflect on a “low-value care” experience (in prep for the Final Project; optional to utilize the shared experience as your FP idea). Share experiences that either you’ve personally experienced as a student, patient or family member. You will have the opportunity throughout the course to reflect on that experience and, with a partner or as an individual, discover ways to improve upon that experience in the future, whether it’s through innovating a systems-wide change, implementing education materials, identifying practical, tangible steps for avoiding this pitfall at the bedside. As we go through the course, we will explore many different ways that HVC has been implemented at all of these levels so through the course, you will be able to assess what is the appropriate modality for your project.
      • At the end, you will post your final project to Sakai and it is expected that you will comment on classmates’ work. Reflecting/commenting on classmates’ projects is worth 5% of your total grade.
  • (5’) Discussion on Results of Pre-Survey - Optional to conduct a pre-survey
  • (45’) Discussion on Module 1: Module 1 introduces the concept of value in health care, the scope of “waste” and inefficiency in the current healthcare system, and how it can be integrated into daily clinical practice.
      • Prompts for discussion:
        • Any general impressions/reflections, or new interesting things learned? **Opportunity to share experiences from clinic**
        • Were you surprised by the way that Dell defines “value?” How have you thought of the word? How would you define it? (For example, prior to this course, I thought value was “doing what we always do in the cheapest, most affordable way possible,” or “doing what we want to do in the most cheap, affordable way possible.”
          • Recall: Value = outcomes that matter to patients/total costs of care
        • How do the core tenets of medicine come into conflict with a fee-for-service healthcare system? (i.e., maleficence, beneficence, patient autonomy, justice)
        • The number one contributor to health care waste is unnecessary services. Does this surprise you? Can you think of any examples of unnecessary care you have experienced, whether as a medical student observing another clinician, as a patient, or something a family member experienced?
          • Potential discussion starters: imaging desired by patients, lack of ease of data transmission and general lack of communication between facilities, fear of malpractice, unnecessary antibiotic prescriptions.
        • What do you think are the biggest barriers to moving from a volume-based health care system to a value-based health care system?
          • Potential discussion starter: the way providers are paid in a fee-for-service system, lack of coordination of care, lack of access to data on outcomes that matter to patients.
**10 min break**
    • (30’) Recap Atul Gawande TedTalk:
      • Intro: Dr. Gawande identifies three skills:
        • 1) Identify where your failures are; 2) devise solutions; 3) the ability to implement
      • Dr. Atul Gawande talks about ways that his institution reduced surgical complications through the implementation of checklists. What are your thoughts on check-lists or algorithms implemented into the practice of medicine? How do we balance the “art” of medicine and simultaneously ensure consistency in the care delivered?
        • How does it make you feel, transitioning the idea of medicine where you as the doctor are the “cowboy” to medicine where you are a member of a “pit crew?” How do you think we can empower physicians to feel both like the leader of the team as well as a member of the team, and derive personal and professional satisfaction from those roles?
        • As a class, tease out the difference between checklists (as in safety checks before surgery) and clinical algorithms. While tempting to group both of these under one "checklist" category, there are important distinctions that should be made.
          • I.e., Some checklists are about safety; others try to ensure diagnostic and treatment consistency.
    • Comments on the Choosing Wisely video -
      • What have you heard about this campaign before?
      • What are your thoughts on the story highlighted in the video where an incidental lung nodule was identified and turned out to be benign? The story feels powerful; and yet - what would’ve happened if it wasn’t benign? Is disease only that which causes symptoms?
      • Do you feel confident in your ability to identify what’s a low- versus high-value test?
        • Clinical students, please comment on your ability to do this in the clinical setting.
          • At the end of the video, the physician says that “Choosing wisely for me is doing what’s best for the individual patient, not always doing what’s the easiest thing.” How do we balance that sentiment with the pit-crew mentality?
    • (15’) Student volunteers discuss their chosen “Things We Do for No Reason.”
      • Give a brief rundown on the “Thing,” and suggestions from SHM to avoid this pitfall.
  • (5’) Wrap-Up
      • Take time after this session to reflect on the discussion and either identify a partner or decide you’d like to work alone on the final project. You will share this decision at the end of the week by email.
      • Explanation for CareZooming exploration + review/questions of assignments for Thursday:
        • We imagine that a lot of the projects will benefit from solutions that are rooted in QI protocols. The course will briefly touch on various QI methodologies - so this is not something to worry about yet. That being said, CareZooming.com (link provided above) is a great resource that aggregates current and past projects conducted at various institutions across the country. You may find that an institution has already tried tackling the issue you’ve identified and it may be helpful to see what they did to address it, what worked, what didn’t.
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