Do No Harm Project Toolkit

The Do No Harm Project uses clinical vignettes written by trainees to improve recognition of the harms that can result from medical overuse. In an era of increasingly depersonalized health care, the Do No Harm Project promotes the importance of thoughtful, individualized care tailored to the patient.
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Overview

Background

The Do No Harm Project is an award-winning program that uses clinical vignettes written by trainees to improve recognition of the harms that can result from “too much medicine” and facilitate delivery of high value, patient-centered care. The goal of the program is to improve clinicians’ awareness of the harms patients may experience because of overuse – medical care that is well intended but nevertheless unneeded or unwanted – and to share ideas about how the delivery of care may be improved in the future. In an era of increasingly depersonalized health care, the Do No Harm Project promotes the importance of thoughtful, individualized care tailored to the patient.

The Project was created at the University of Colorado School of Medicine by Tanner Caverly, MD, MPH and Brandon Combs, MD, after Dr. Caverly attended the Lown Institute’s 2012 Avoiding Avoidable Care conference. In 2013, the program was recognized by the American Board of Internal Medicine Foundation and Costs of Care as a winner of their Teaching Value/Choosing Wisely Competition. It has also inspired the Teachable Moment series in JAMA Internal Medicine which, since 2014, has been publishing vignettes by trainees from around the world describing harm or near harm related to avoidable medical care. More recently, this program has led to an Evergreen Award from the American College of Physicians. Conveniently, the Do No Harm Project is one way to meet the aims of the Clinical Learning Environment Review (CLER) program from ACGME.

 

About the Project

Trainees participating in the Project identify a case where a patient was harmed, or nearly so, by medical care that was seemingly reasonable, but nevertheless avoidable on the basis of scientific evidence or patient preferences. Participants then write a clinical vignette reflecting on the patient’s experience and the relevant scientific evidence that informs how we can do better going forward. Vignettes can be posted in a virtual forum for others to read or presented to colleagues in a “morning report” format to promote discussions about how similar harms from overuse can be avoided in the future. Participation in the program has been encouraged by local and national competitions where trainees with the best vignettes, as determined by the selection criteria below, receive rewards for their submissions.

Trainees have found clinical vignettes to be a potent way to humanize the harms of overuse, and provide a persuasive counterbalance to the “more is better” culture.

The Do No Harm Project is expanding to institutions across the country and such efforts are underway in residency programs at UCSF, The University of Alabama-Birmingham, the University of North Carolina Chapel-Hill, Saint Louis University, and in the third-year longitudinal integrated clerkship for medical students at the University of Colorado.

 

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