Use of simulation to assess incoming interns’ recognition of opportunities to choose wisely

Kathleen M. Wiest, Jeanne M. Farnan, Ellen Byrne, Lukas Matern, Melissa Cappaert, Kristen Hirsch, Vineet M. Arora*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


BACKGROUND: Despite increasing healthcare costs, training on cost-consciousness is lacking in graduate medical education (GME). Medical centers must consider how best to incorporate value-based training into their GME curricula. OBJECTIVE: To incorporate low-value principles into an existing GME simulation exercise and assess incoming interns’ recognition of low-value care. METHODS: Choosing Wisely™ lists were reviewed to identify 4 low-value hazards to be embedded into a simulated hospital room in addition to the 8 patient safety hazards used previously. Interns were given 10 minutes to independently review a mock chart and list all hazards they identified in the simulation. Interns completed a short survey on their prior training in medical school and a follow-up survey one month into internship. T tests used to compare identification of low-value vs safety hazards and to associate performance with prior training. RESULTS: The mean percentage of hazards correctly identified was 50.4% (standard deviation [SD] 11.8%). Interns identified significantly fewer low-value hazards (mean 19.2%, SD 18.6%) than safety hazards (mean 66.0%, SD 16.0%; P <.001). For example, while 96% of interns identified the hand hygiene hazard, only 6% identified the unnecessary blood transfusion and none identified the unnecessary stress ulcer prophylaxis. Interns who self-reported as confident in their ability to identify hazards were not any more likely to correctly identify hazards than those who were not confident. CONCLUSIONS: The “Room of Horrors” simulation revealed poor awareness of low-value care among interns. The simulation highlights a promising model for the prioritization and inclusion of value-based experiential training in GME.

Original languageEnglish (US)
Pages (from-to)493-497
Number of pages5
JournalJournal of Hospital Medicine
Issue number7
StatePublished - Jul 2017

ASJC Scopus subject areas

  • Fundamentals and skills
  • Care Planning
  • Assessment and Diagnosis
  • Health Policy
  • Leadership and Management
  • Internal Medicine


Dive into the research topics of 'Use of simulation to assess incoming interns’ recognition of opportunities to choose wisely'. Together they form a unique fingerprint.

Cite this