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High-value care education can learn from the evidence-based medicine movement: moving beyond competencies and curricula to culture
  1. Christopher Moriates1,2,
  2. William K Silverstein3,4,5,
  3. Renato Bandeira de Mello6,
  4. Lorette Stammen7,
  5. Brian M Wong8
  1. 1Departments of Internal Medicine and Medical Education, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
  2. 2Executive Director, Costs of Care, Boston, Massachusetts, USA
  3. 3Department of Medicine, University of Toronto, Toronto, ON, Canada
  4. 4Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
  5. 5Choosing Wisely Canada, Toronto, ON, Canada
  6. 6Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porte Alegre, Brazil
  7. 7School of Health Professions Education, Maastricht University, Maastricht, Limburg, Netherlands
  8. 8Department of Medicine and Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Christopher Moriates, The University of Texas at Austin Dell Medical School, Austin TX 78713, Texas, USA; Cmoriates{at}

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High-value care (HVC) is ‘the best care for the patient, with the optimal result for the circumstances, delivered at the right price’.1 Simply put, it means ensuring only appropriate tests, treatments and procedures are provided to patients, to mitigate overuse. Adopting HVC is increasingly important given that unnecessary medical interventions are costly, harmful to patients and increase the carbon footprint of healthcare. Embedding HVC into routine practice represents a profound shift in the dominant medical culture from one that traditionally placed emphasis on physician ‘thoroughness’ to one that prioritises ‘appropriateness’ to address both underuse and overuse of medical interventions.

There are many similarities between the current approach for introducing HVC into medical education and the way evidence-based medicine (EBM) was previously incorporated. Both HVC and EBM are pioneering movements relevant to providing quality and equity in healthcare. In the 1990s, EBM quickly ‘evolved into an emblem for an entire generation’.2 Some of the key components for successful EBM adoption were integration throughout all elements of physician curricula, promoting EBM role models who demonstrate the real-world application of EBM in clinical decision-making and embedding EBM in a more structured way into everyday clinical care.3 4 To advance HVC education and support a cultural shift to embrace appropriateness, HVC education proponents can learn lessons from how EBM was integrated into medical training.

Setting the foundation: HVC competencies and curricula

If students perceive a dichotomy between [evidence-based practice] and actual clinical care, then ‘never the twain shall meet’ requiring integration in such a way that it is ‘seen as part of the basics of optimal care’. [Professor Gordon Guyatt]3

The key lessons from the EBM experience to advance HVC curricula is to develop consensus competencies that frame this practice as foundational and integrated across all domains, start teaching principles from the beginning of medical education, focus …

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  • Twitter @ChrisMoriates, @WKSilverstein, @renatogbm

  • Contributors CM wrote the initial draft. CM, WS, RGBdM, LS and BW contributed to the concepts, writing of sections of the paper and reviewing for intellectual content. CM is responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.