Medical education lays the foundation for every physician’s future practice. When students are taught about resource stewardship principles early on in their education, they are more likely to implement those ideas into their clinical careers. That’s why medical students and Students and Trainees Advocating for Resource Stewardship (STARS) leaders Juila Pei and Charuta Sahasrabudhe worked to implement Choosing Wisely into the medical school curriculum at the University of British Columbia (UBC).

Julia and Charuta both learned about the work of Choosing Wisely through their own research and were surprised to find that it was not yet fully integrated into what they were learning in the classroom. When brainstorming ideas for their STARS project, they recognized a need to help bridge the gap between medical research, public health best practices, and further knowledge translation efforts.

“I felt like there was a lot of opportunity for discussion about these topics that wasn’t happening yet, so we decided to go down the route of trying to integrate Choosing Wisely pearls into the existing curriculum,” shares Charuta.

The process of integration involved many meetings with faculty and university leadership. To prepare, the pair went through the first-year curriculum and short listed Choosing Wisely content and recommendations that were relevant to each week of learning material. To launch their project, they formally pitched the idea to UBC medical school administration, including the director of the first year course, Dr. Clarissa Wallace. The support of Dr. Wallace became instrumental to the success of their work as she helped them gather the contact information for professors and curriculum leads who would be implementing curriculum changes.

Both Julia and Charuta feel that the communication piece of this project was the most demanding element. “It was very challenging,” says Julia. “UBC’s curriculum is designed such that we have a different lead instructor for almost every week of the year. For example, instead of having one set person to reach out to for all the cardiology course weeks, it was a different specialist for each week.”

In the end, they were able to successfully integrate eight recommendations into the second semester of the first-year curriculum. These integrations offered practical strategies for implementing Choosing Wisely principles in clinical settings and launched a broader resource stewardship discussion. According to the online survey distributed to the first-year class, nearly 100 per cent of respondents found the integration to be beneficial and many reported that it helped introduce a resource stewardship lens into their practice. Further, several students provided feedback on possible areas for expansion. Some of these ideas for the future include, case-based learning sessions, where students have small group discussions on course relevant topics.

“Ultimately, this is one of the best ways to immerse students, because all of this is mandated course material,” Julia explains of their thought process. “It would be more challenging to have students attend an event or extracurricular on this topic, but they all attend lectures, so having the material integrated means that the concepts are more likely to be absorbed, which we saw in the results.”

“We were encouraged by the receptiveness of the week leads to incorporating recommendations into their curricula,” adds Charuta. “Some even shared resource stewardship pearls from their own clinical experience.”

In addition to the curriculum work, the co-STARS spread awareness of Choosing Wisely family medicine recommendations by distributing ID badge cards to medical students across campus using a template created by the 2022-23 University of Toronto STARS students. The cards included a QR code for students to easily access further information about recommendations and served as a practical tool for completing their family medicine clerkship, as well as a general reminder to integrate Choosing Wisely principles.

This work has already had an immense impact on the UBC medical student body, but their ambitions go far beyond just first-year lectures. “The ultimate goal for us would be to have resource stewardship be an official objective in the UBC curriculum,” Charuta shares. “That’s something that we’re working with current STARS to continue developing.”

As they have wrapped up their time as STARS leaders, Julia and Charuta have made sure to pass on as much knowledge as possible, so the incoming leaders have the tools they need to continue the work, even creating email templates and a suggested timeline. The hope is that these efforts leave the UBC STARS leaders prepared for what’s next and able to continue building a future workforce that is engaged in resource stewardship work.