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Paper text:
les cots croissants reprsentent une menace importante pour la prennit des soins de sant . de plus en plus , on sattend que les mdecins aient les comptences ncessaires pour grer les ressources .
lors dune journe de rflexion nationale pour les rsidents en infectiologie et en microbiologie , la gestion des ressources a t aborde conformment au cadre choosing wisely .
pendant la journe de rflexion canadienne annuelle de 2014 pour les rsidents en infectiologie et en microbiologie tenue  toronto , en ontario , des rsidents en infectiologie ( n=50 ) et en microbiologie ( n=17 ) reprsentant 11 universits canadiennes rparties dans six provinces ont t invits  participer  un groupe delphi modifi . avant la journe de rflexion , ils ont t invits  soumettre jusqu cinq pratiques que les spcialistes de linfectiologie ou de la microbiologie ne devraient pas effectuer systmatiquement parce que leurs avantages ne sont pas dmontrs ou quelles comportent des risques potentiels pour les patients .
ils ont examin ces pratiques lors de forums en petits et grands groupes selon une mthode itrative par sondage lectronique , jusqu atteindre un consensus pour cinq pratiques .
une liste dfinitive a t cre pour des besoins dducation et pour que les rsidents envisagent de la respecter .
cette liste ne visait toutefois pas  remplacer les documents officiels approuvs par la socit .
les rsidents sont parvenus  un consensus sur cinq pratiques de faible valeur qui relvent des mdecins en infectiologie et en microbiologie .
aprs la journe de rflexion , 20 participants ( 32 % ) ont rempli le sondage de suivi .
la majorit dentre eux ( 75 % ) trouvaient que cette sance tait au moins aussi pertinente que les autres sances auxquelles ils avaient assist pendant la journe de rflexion , et 95 % ont indiqu quau moins une partie de ce qui avait t abord tait nouveau pour eux .
depuis leur retour au sein de leur tablissement , neuf ( 45 % ) rpondants avaient intgr ce quils avaient appris  leur pratique , quatre ( 20 % ) ont dclar avoir envisag un projet li  la sance et un ( 5 % ) a affirm avoir lanc un projet .
le prsent forum dducation a dmontr que les rsidents peuvent sinvestir pour cerner les pratiques de faible valeur et en discuter .
il faudra intgrer la grance de lducation aux programmes de rsidence pour amliorer la valeur des soins offerts par les futurs membres de notre profession .
during the 2014 annual canadian infectious diseases and microbiology resident retreat held from august 11 to 14 , 2014 , in toronto , ontario , infectious diseases and microbiology trainees ( representing 11 canadian universities and all six provinces with training programs in infectious diseases and microbiology [ british columbia , alberta , manitoba , ontario , quebec and nova scotia ] ) who enrolled in the retreat , were asked to participate in a modified delphi panel ( 6 ) modelled after the choosing wisely initiative ( figure 1 ) .
participants included 50 residents in infectious diseases ( adult infectious diseases [ n=35 ] , pediatric infectious diseases [ n=15 ] and microbiology [ n=17 ] ) .
the retreat was an educational forum organized by residents in the adult infectious diseases program at the university of toronto ( toronto , ontario ) , who determined the curriculum and teaching formats for the sessions .
in advance of the retreat , attendees were asked to participate in this session beginning with reflection of both personal practice patterns and those of their attending physicians , to identify unnecessary tests or procedures falling within their own scopes of practice that could be eliminated ( 3 ) .
these practices were defined as those lacking proven benefit or posing potential harm to patients .
a brief description of the format of the session was provided , including examples of appropriate and inappropriate submissions in the form of declarative statements ( 3 ) .
an example of an inappropriate recommendation included  do not routinely order urine cultures to assess patients with changes in mental status who do not have signs or symptoms of urinary tract infection 
, because infectious disease physicians and microbiologists are not typically the individuals who assess these patients and order this test . of 67 participants from 11 canadian universities ,
these were formatted into 15 declarative statements by three of the authors ( drm , wlg , jal ) and were accompanied by supporting evidence .
the 90 min session included several educational formats . a collaborative approach to this exercise was emphasized . to begin , a lecture introduced the concepts of high- and low - value health care , resource stewardship , the choosing wisely campaign and included a review of the list of declarative statements .
the overall goal of the session was for the participants to apply the knowledge learned from the large group lecture to finalize a list of statements , which they determined to be actionable and through implementation , may improve the value of care provided .
following the large group lecture , participants were divided into small groups ( eight to 10 participants per group ) ; residents in the adult infectious diseases program at the university of toronto were responsible for facilitating discussions to arrive at consensus within each group regarding their  top five list , which they presented to the group at large .
all participants were then polled in real - time using interactive polling software ( www.polleverywhere.com ) and a  top 10 list was created .
using a modified delphi method ( 6 ) , polling and open discussion continued through three additional rounds , until consensus was reached .
final statements were formalized and disseminated to all participants to both ensure integrity of the statements , and to encourage engagement of faculty and residents at their own institutions in further discussions .
two months following the retreat , participants were surveyed to obtain quantitative feedback on the impact of this session .
participants achieved consensus regarding  five things physicians and patients should question  ( 3 ) related to infectious diseases practice ( table 1 ) .
each statement pertains to a test or procedure encountered in infectious diseases or microbiology practice for which there is an evidence base to support reducing or eliminating its use ( 711 ) .
eighty percent of responders agreed / strongly agreed that an effective presentation style was used ( 55% somewhat agree ; 25% strongly agree ) .
the majority of participants ( 75% ) believed that the session was at least as relevant as other sessions at the retreat ( as relevant 55% ; somewhat more relevant 15% ; more relevant 5% ) , with 95% indicating that at least some of the material discussed was new to them ( 80% somewhat new to respondent ; 15% new to respondent ) .
after returning to their home institutions , nine respondents ( 45% ) reported they have incorporated what they learned into their daily practice .
four respondents ( 20% ) reported that they have considered initiating a project related to the session and one respondent ( 5% ) reported having initiated a project .
through this national educational forum , we demonstrated feasibility of introducing the concept of high - value health care delivery into the curriculum of infectious diseases and microbiology trainees , through the generation of individual and peer - developed statements modelled after the choosing wisely campaign .
the items , identified by the residents , have not been rigorously scrutinized for official endorsement by any professional society , but represent the opinions of infectious diseases and microbiology trainees who have not yet completed their training . with additional years of training and practice , other declarative statements may have been included and some excluded .
however , the primary objective of this session was to facilitate reflection and education regarding resource stewardship at the trainee level . despite a low response rate to our postretreat survey
, we demonstrated that participants who replied are contemplating or have initiated projects related to this project , which was a goal of the session .
we conclude that an interactive , educational forum modelled after the choosing wisely campaign was an effective way of introducing the concepts of resource stewardship to subspecialty trainees . embedding resource stewardship in residency training curricula , as highlighted at our retreat ,
represents one approach that may improve the value of care offered by the future members of our profession ( 4 ) .
background : rising costs present a major threat to the sustainability of health care delivery . 
 resource stewardship is increasingly becoming an expected competency of physicians . 
 the choosing wisely framework was used to introduce resource stewardship at a national educational retreat for infectious disease and microbiology residents.methods:during the 2014 annual canadian infectious disease and microbiology resident retreat in toronto , ontario , infectious disease ( n=50 ) and microbiology ( n=17 ) residents representing 11 canadian universities from six provinces , were invited to participate in a modified delphi panel . 
 participants were asked , in advance of the retreat , to submit up to five practices that infectious disease and microbiology specialists should not routinely perform due to lack of proven benefit(s ) and/or potential harm to patients . 
 submissions were discussed in small and large group forums using an iterative approach involving electronic polling until consensus was reached for five practices . 
 a finalized list was created for both educational purposes and for residents to consider enacting ; however , it was not intended to replace formal society - endorsed statements . 
 a follow - up survey at two - months was conducted.results:consensus was reached by the residents regarding five low - value practices within the purview of infectious diseases and microbiology physicians . after the retreat , 20 participants ( 32% ) completed the follow - up survey . 
 the majority of respondents ( 75% ) believed that the session was at least as relevant as other sessions they attended at the retreat , including 95% indicating that at least some of the material discussed was new to them . since returning to their home institutions , nine ( 45% ) 
 respondents have incorporated what they learned into their daily practice ; four ( 20% ) reported that they have considered initiating a project related to the session ; and one ( 5% ) reported having initiated a project.conclusions:the present educational forum demonstrated that trainees can become actively engaged in the identification and discussion of low - value practices . 
 embedding residence training programs with resource stewardship education will be necessary to improve the value of care offered by the future members of our profession .