The Choosing Wisely Campaign is an ABIM Foundation initiative which ‘seeks to advance a national dialogue on avoiding unnecessary medical tests, treatments and procedures’. The Choosing Wisely STARS (Students & Trainees Advocating for Resource Stewardship) Program was developed with the goal of promoting student-led initiatives that ‘advance health care value in medical education’. Although some US medical schools have incorporated high value care into their pre-clinical curriculum, there is no standardized approach to providing such instruction. Our initiative sought to provide a sustainable model by which high value care principles could be integrated into the existing pre-clinical curriculum at the University of Vermont’s Larner College of Medicine.
Starting in 2019, STARS students worked with the director of the cardiovascular, respiratory, and renal (CRR) pathophysiology course to identify guidelines from the ABIM Choosing Wisely Campaign which were relevant to topics covered in the pre-clinical course. For example, a course on EKG basics was identified as an opportunity to discuss clinical scenarios in which an EKG may be unnecessary. Student representatives contacted teaching faculty directly to request the integration of appropriate Choosing Wisely guidelines into specific class sessions. STARS students provided faculty with the selected clinical guidelines and accompanying multiple-choice case questions. Faculty were invited to incorporate the material into the class sessions or supplemental curricular materials via their preferred method. The Choosing Wisely guidelines and example questions were also provided to students in their online course materials. At the conclusion of each year’s course from 2019 through 2021, students and teaching faculty were invited to complete an anonymous, Likert-style survey (1–5 scale, from ‘strongly disagree’ to ‘strongly agree’) to assess their perceptions of the curriculum.
In total, 420 students participated in the CRR course from 2019 through 2021. Of those students, 171 completed the survey (response rate 40.7%). Among the student respondents, 80% agreed the intervention increased their awareness of high value care, 81% agreed it added helpful clinical context to their foundational coursework, and 92% agreed the content was valuable during the second year of medical school. In contrast, 1% recommended discontinuing the program. A total of 35 faculty members were involved in the initiative from 2019 through 2021, and 24 completed the survey (response rate 68.6%). During the inaugural year, 44% of faculty respondents agreed that the curriculum increased student awareness of high value care and 56% agreed with continuing the curriculum. By 2021, 75% of faculty respondents agreed with continuing the program, 88% agreed that it increased medical student awareness of high value care, and 100% agreed that it is valuable for students to discuss Choosing Wisely recommendations during the second year of medical school.
Medical students consistently reported positive perceptions of the intervention, and although faculty initially expressed reservations about incorporating Choosing Wisely into the pre-clinical curriculum, their perceptions appeared to evolve over the three-year period. In the absence of a formal and standardized curriculum, this model offers an effective opportunity to increase medical student familiarity with high value care.
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