Welcome to the Choosing Wisely Campaign series! This is the third episode of a 6-part series exploring the ABIM Foundation’s Choosing Wisely Lists. This campaign aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures.

Our second case-based episode presents an infant with diarrhea and diaper dermatitis. After a clear discussion of the case and thoughtful consideration of the etiology and treatment strategies, we use the AAP’s Choosing Wisely dermatology and gastroenterology, hepatology, and nutrition lists to create a resource-conscious care plan that is safe and patient-centered.

In the coming episodes, we’ll explore the pediatric lists and apply our knowledge to cases of common presentations seen in primary and acute care pediatrics.

Series Learning Objectives:

1. Introduction to the Choosing Wisely Campaign: Understand the origins, historical precedent, and primary goals of the campaign.
2. Case-Based Applications: Explore five common presentations in primary and acute care pediatrics, applying concepts from various Choosing Wisely lists to guide management and resource stewardship.
3. Effective Communication: Learn strategies for engaging in tough conversations with parents and colleagues to create allies and ensure evidence-based practices are followed.

Modified rMETRIQ Score: 15/15

Competencies:

AACN Essentials:

• 1: 1.1 g, 1.2f, 1.3de
• 2: 2.1 de, 2.2g, 2.4fg, 2.5 hijk
• 7: 7.2 ghk
• 9: 9.1ij, 9.2ij, 9.3ik

NONPF NP Core Competencies:

• 1: NP1.1h, NP 1.2km, NP 1.3fjh
• 2: NP2.1jg, NP2.2kn, NP 2.4hi, NP2.5 klmno
• 7: NP7.2m
• 9: NP9.1mn, NP9.2n, NP9.3p

References

ABIM Foundation. (2019). Communicating about overuse with vulnerable populations. Retrieved from https://www.choosingwisely.org/files/Communicating-About-Overuse-to-Vulnerable-Population_Final2.pdf

AAP Section on Dermatology. (2021). Five things physicians and patients should question. https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWDermatology.pdf

AAP Section on Gastroenterology, Hepatology, and Nutrition. (2023). Five things physicians and patients should question. https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWGastroenterology.pdf

Harriet Lane Service (Johns Hopkins Hospital), Anderson, C. C., Kapoor, S., & Mark, T. E. (2024). The Harriet Lane handbook: a manual for pediatric house officers (23rd ed.). Elsevier.

Jauregui, J., Nelson, D., Choo, E., Stearns, B., Levine, A. C., Liebmann, O., & Shah, S. P. (2014). External validation and comparison of three pediatric clinical dehydration scales. PloS one, 9(5), e95739. https://doi.org/10.1371/journal.pone.0095739

Johnson, H., & Yu, J. (2022). Current and Emerging Therapies in Pediatric Atopic Dermatitis. Dermatology and therapy, 12(12), 2691–2703. https://doi.org/10.1007/s13555-022-00829-4

Semon, A. K., Keenan, O., & Zackular, J. P. (2021). Clostridioides difficile and the Microbiota Early in Life. Journal of the Pediatric Infectious Diseases Society, 10(Supplement_3), S3–S7. https://doi.org/10.1093/jpids/piab063

Welcome to the Choosing Wisely Campaign series! This is the second episode of a 6-part series exploring the ABIM Foundation’s Choosing Wisely Lists. This campaign aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures.

The first of our case-based episodes presents a school age child with syncope. After a clear discussion of the case and thoughtful consideration of an acute care differential, we use the AAP’s Choosing Wisely cardiac list to create a resource-conscious care plan that is safe and patient-centered.

In the coming episodes, we’ll explore the pediatric lists and apply our knowledge to cases of common presentations seen in primary and acute care pediatrics.

Series Learning Objectives:

1. Introduction to the Choosing Wisely Campaign: Understand the origins, historical precedent, and primary goals of the campaign.
2. Case-Based Applications: Explore five common presentations in primary and acute care pediatrics, applying concepts from various Choosing Wisely lists to guide management and resource stewardship.
3. Effective Communication: Learn strategies for engaging in tough conversations with parents and colleagues to create allies and ensure evidence-based practices are followed.

Competencies:

AACN Essentials:

• 1: 1.1 g, 1.2f
• 2: 2.1 de, 2.2g, 2.5 ij
• 6: 6.1 i
• 7: 7.2 ghk
• 9: 9.1ij, 9.2ij, 9.3ik

NONPF NP Core Competencies:

• 1: NP1.1h, NP 1.2km
• 2: NP2.1jg, NP2.2kn, NP2.5 lo
• 6: NP6.1o
• 7: NP7.2m
• 9: NP9.1mn, NP9.2n, NP9.3p

References:

AAP Section on Cardiology and Cardiac Surgery. (2020). Five things physicians and patients should question. https://downloads.aap.org/AAP/PDF/Choosing%20Wisely/CWCardio.pdf

Gilpin, K., & Goode, Z. (2024). Syncope. Pediatrics in review, 45(10), 606–608. https://doi.org/10.1542/pir.2023-006053

Welcome to the Choosing Wisely Campaign series! This 6-part series will explore the ABIM Foundation’s Choosing Wisely Campaign, its historical precedent, and its goals. We will discuss how this initiative aims to promote conversations between clinicians and patients to avoid unnecessary medical tests, treatments, and procedures.

The introduction episode dives into the historic 2010 editorial in the New England Journal of Medicine that inspired over 80 professional societies to write their “Top 5 Lists” of tests and procedures that could be avoided in evidence-based care. To better understand the problem, we then pick apart the survey that provided insight into why we over order and the harm it causes to vulnerable populations.

In the coming episodes, we’ll explore the pediatric lists and apply our knowledge to cases of common presentations seen in primary and acute care pediatrics.

Author: Becky Carson, DNP, APRN, CPNP-PC/AC

www.thepedsnp.com

Instagram: @thepedsnppodcast

Series Learning Objectives:

1. Introduction to the Choosing Wisely Campaign: Understand the origins, historical precedent, and primary goals of the campaign.
2. Case-Based Applications: Explore five common presentations in primary and acute care pediatrics, applying concepts from various Choosing Wisely lists to guide management and resource stewardship.
3. Effective Communication: Learn strategies for engaging in tough conversations with parents and colleagues to create allies and ensure evidence-based practices are followed.

Competencies:

AACN Essentials:

• 1: 1.1 g, 1.2f
• 2: 2.1 de, 2.2g, 2.5 ij
• 6: 6.1 i
• 7: 7.2 ghk
• 9: 9.1ij, 9.2ij, 9.3ik

NONPF NP Core Competencies:

• 1: NP1.1h, NP 1.2km
• 2: NP2.1jg, NP2.2kn, NP2.5 lo
• 6: NP6.1o
• 7: NP7.2m
• 9: NP9.1mn, NP9.2n, NP9.3p

Modified rMETRIQ Score: 15/15

Learn more about our peer review process at www.thepedsnp.com/peerreview

References:

ABIM Foundation. (2019). Communicating about overuse with vulnerable populations. Retrieved from https://www.choosingwisely.org/files/Communicating-About-Overuse-to-Vulnerable-Population_Final2.pdf

Brody, H. (2010). Medicine's ethical responsibility for health care reform--the Top Five list. The New England journal of medicine, 362(4), 283–285. https://doi.org/10.1056/NEJMp0911423

Lipitz-Snyderman, A., & Bach, P. B. (2013). Overuse of health care services: when less is more … more or less. JAMA internal medicine, 173(14), 1277–1278. https://doi.org/10.1001/jamainternmed.2013.6181

PerryUndem Research/Communication. (2014). Unnecessary tests and procedures in the health care system. Retrieved from https://www.choosingwisely.org/files/Final-Choosing-Wisely-Survey-Report.pdf

Smith-Bindman, R., Chu, P. W., Azman Firdaus, H., Stewart, C., Malekhedayat, M., Alber, S., Bolch, W. E., Mahendra, M., Berrington de González, A., & Miglioretti, D. L. (2025). Projected Lifetime Cancer Risks From Current Computed Tomography Imaging. JAMA internal medicine, e250505. Advance online publication. https://doi.org/10.1001/jamainternmed.2025.0505

Wyman, O. (2019). Right Place, Right Time: Health Information & Vulnerable Populations. https://www.oliverwyman.com/RightPlaceRightTime.html