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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Clinical vignettes should describe 1) seemingly reasonable though unnecessary care resulting in harm or harm that was narrowly avoided; or 2) misdiagnosis of patient preferences that subsequently led to unnecessary care and harm, or harm that was narrowly avoided. These vignettes do not have to be particularly unusual cases and the harms do not have to be extraordinary, but they should be well researched and thoughtfully written. Instances of medical errors or obvious malpractice should be avoided.
Authors: 3 or fewer. The first author must be a trainee (professional student, intern, resident, fellow, master’s or doctoral student, or post-doctoral student).
Format: Suggested length is 600 words, and not more than 800 words (excluding references). Submissions should include a clinical vignette, which provides an engaging story with pertinent clinical and historical findings. Also, vignettes must include a succinct summary of the clinical issues describing the evidence for medical overuse and suggesting an alternative approach going forward.
Patient consent is required for publication in JAMA Internal Medicine’s Teachable Moments Series, though is not viewed as mandatory so long as cases are fully de-identified.
References: 5 or fewer.
We suggest that a local Do No Harm Project champion identify a clinical rotation or other venue where time is available to engage trainees on the topics of medical overuse/high value care and encourage submission of clinical vignettes. Ideally, trainees who participate in this program will have dedicated time to write their vignette in order to ensure adequate time for reflection and a resultant high quality product. Local champions such as chief residents or faculty can review proposed cases – e.g. the “one liner” – to be sure they are appropriate instances of “reasonable overuse.” At any point along the way, champions are encouraged to provide final edits, offer suggestions for additional citations, and facilitate publication in JAMA Internal Medicine’s Teachable Moments series. If a writing day is provided for participants, we suggest that a draft be turned in by the end of the writing day. Please see a suggested basic structure for The Do No Harm Project below:
|Email notification 2 weeks prior to rotation|
|Housestaff reflect on case of harm from overuse|
|10 minute “pitch” about the problem of overuse and opportunity to participate in project|
|Interested housestaff send basic description to project champion(s)|
|Appropriate cases approved for writing day|
|References and tips for writing case provided by champion(s)|
|First draft due by end of writing day|
|Revisions made by faculty; final draft due within 30 days|
|Final draft posted online, participant entered into competition, encouraged to submit for publication|
Suggested selection criteria for local competitions:
Vignettes should be judged on the following criteria:
Prizes may be offered for the best vignettes to encourage participation. Suggested prizes: