Wisdom of the Crowd: Shark Tank! and Other Tools to Teach High Value Care

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By: Vineet Arora, Christopher Moriates, and Neel Shah

Vineet Arora is director of educational initiatives at Costs of Care, Christopher Moriates is director of implementation initiatives at Costs of Care, and Neel Shah is founder and executive director of Costs of Care. All are co-chairing the 2nd Annual Teaching Value & Choosing Wisely Challenge with funding from the American Board of Internal Medicine (ABIM) Foundation.

There is no time like the new year to make teaching resolutions. As medical educators consider how to add teaching value to their already full plate, we hope that our recent innovation report highlighting the “wisdom of the crowd” serves as a useful guiding light. On the heels of the incredibly successful Choosing Wisely campaign, the ABIM Foundation engaged our team at Costs of Care with an intriguing question: What are the best ways to teach trainees value? It was tempting for us as academics to consider the gold standard—a rigorous systematic review. However, during this fast-paced time of change in our clinical environments, we knew that a systematic review was unlikely to uncover the diamonds in the rough—the innovations that are truly groundbreaking but have not had time to go through the peer-reviewed publication process. Moreover, there could be bright ideas among medical educators across the nation that have not yet been tested or vetted but hold great promise.

Leveraging the principles of crowdsourcing, we launched the Teaching Value & Choosing Wisely Challenge, which aimed to uncover the best innovations and bright ideas that could be scalable and generalizable to a larger group of trainees. When one launches something new, it is always hard to predict what will happen. We are fortunate the adage “If you build it, they will come” served as our mantra. Using a variety of publicity techniques, including e-blasts through professional societies, postcard flyer distributions at national meetings, and capitalizing on social media channels like the weekly #MedEd Chat on Twitter, we were able to engage a large and diverse audience of trainees and educators to answer our challenge. In the end, we collected 74 submissions from over 14 specialties, with submitters ranging from medical students to department chairs.

Although we had a panel of esteemed judges select the ultimate winners, it was during the review process that we were struck by a number of consistent themes that had emerged. Some of the themes were not “new” per se but rather were time-honored traditional teaching tools, reinvented to address this new problem, such as the basic case vignette. For example, the Do No Harm project at the University of Colorado solicits case vignettes from trainees about overuse and restraint. Other approaches used “gamification” to capitalize on the intrinsic competitive spirit among physicians; Rob Fogerty conceived the I-CARE competition at Yale in which attendings competed with residents and interns to solve the morning report case while spending the fewest resources.

These are just a few of the many innovations that we encourage you to read about in our report. Moreover, we hope you will learn from these innovations. We know that we have. Taking a page out of Rob Fogerty’s playbook, we recently used gamification at the Institute for Healthcare Improvement’s national conference to play “Shark Tank! High Value Care Edition,” in which spirited groups pitched entrepreneurial ideas for value improvement initiatives at their “mock hospital.” While an aptly named team called “Victors of Value” reigned supreme, we were encouraged to see everyone rise to the occasion, coming up with inventive ways to provide patients with better care at lower cost, all in the span of just 30 minutes of brainstorming.

We know that if you are reading this, you probably have a bright idea that you think is worth mention as well. We encourage you to enter the fray and submit 500 words by January 15 to the 2nd Annual Teaching Value & Choosing Wisely Challenge. Winners will be invited to present at a special session at the 100th Annual American College of Physicians Meeting, and all participants will be invited to join a new Teaching Value in Healthcare Community to continue to share and learn from each other during the year.

After all, you may have an idea that medical educators need to hear!

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