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Learners as Leaders: A Global Groundswell of Students Leading Choosing Wisely Initiatives in Medical Education

Born, Karen B. PhD; Moriates, Christopher MD; Valencia, Victoria MPH; Kerssens, Marlou MSc; Wong, Brian M. MD, FRCPC

doi: 10.1097/ACM.0000000000002868

Resource stewardship and reducing low-value care have emerged as urgent priorities for health care delivery systems worldwide. However, few medical schools’ curricula include adequate content to allow learners to master the knowledge, skills, and attitudes needed to contribute to this transformation toward value-based health care. This article describes a program to launch student-led curriculum enhancement initiatives in 7 countries. The program, called STARS (Students and Trainees Advocating for Resource Stewardship), was inspired by Choosing Wisely, a campaign by the American Board of Internal Medicine Foundation that seeks to promote conversations on avoiding unnecessary medical tests, treatments, and procedures.

The initial STARS model, which originated in Canada in 2015, included a leadership summit, where students from multiple medical schools learned about Choosing Wisely principles, leadership, and advocacy. These students then led grassroots efforts at their local medical schools with faculty and other students to raise awareness and advocate for changes related to resource stewardship. Student-led efforts resulted in the integration of Choosing Wisely principles into case-based learning, the creation of student interest groups and electives, the launch of social media campaigns, and the organization of special presentations by local experts.

The rapid spread of similar programs in 6 other countries (Italy, Japan, the Netherlands, New Zealand, Norway, and the United States) by 2018 suggests that STARS resonates across multiple settings and signals the potential for such a model to advance other important areas in medical education. This article documents results and lessons learned from the first 4 years of the program.

K.B. Born is knowledge translation lead, Choosing Wisely Canada, and assistant professor, Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

C. Moriates is assistant dean for health care value, Department of Medical Education, and associate chair for quality, safety, and value and associate professor of internal medicine, Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas, and executive director, Costs of Care, Boston, Massachusetts.

V. Valencia is assistant professor, Department of Medical Education, Dell Medical School, University of Texas at Austin, Austin, Texas.

M. Kerssens is junior consultant at Adviestalent, part of Twynstra Gudde, Amersfoort, the Netherlands, and was recently a summer research intern with Choosing Wisely Canada, Toronto, Ontario, Canada.

B.M. Wong is medical education lead, Choosing Wisely Canada, associate director, Centre for Quality Improvement and Patient Safety, University of Toronto, and associate professor, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

The authors have informed the journal that they agree that both Karen B. Born and Christopher Moriates completed the intellectual and other work typical of the first author.

Funding/Support: Choosing Wisely Canada STARS was funded by an ABIM Foundation education grant from September 2015 to December 2018. The Canadian Medical Association is funding STARS from March 2019 to April 2022. The U.S. Choosing Wisely STARS program was funded by grants from the ABIM Foundation and the Josiah Macy Jr. Foundation.

Other disclosures: None reported.

Ethical approval: Choosing Wisely STARS was approved by the University of Texas Institutional Review Board in 2017. The University of Toronto Research Ethics Board approved this study in June 2018.

Previous presentations: Choosing Wisely STARS U.S. was presented during poster presentations at the 2018 High Value Practice Academic Alliance national meeting, September 2018, Baltimore, Maryland, and Learn Serve Lead 2018: The AAMC Annual Meeting, November 2018, Austin, Texas.

Correspondence should be addressed to Brian M. Wong, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room H466, Toronto, ON M4N 3M5, Canada; telephone: (416) 480-6100, ext. 83709; email:; Twitter: @Brian_M_Wong.

Copyright © 2019 by the Association of American Medical Colleges