Evidence That Drives Real Change

Authors: Ragavan, M.V., Wallingford, S., Chino, F. et al.

Year: 2026

Abstract:
The healthcare cost crisis in the USA has become unsustainable, with patients facing rising premiums and deductibles and providers unable to meet their bottom lines, forcing practice mergers and buyouts that further exacerbate gaps in care access. Promoting high value care has been a stated priority of health systems for nearly two decades, but practical implementation within a largely fee-for-service system has remained limited. Practicing clinicians must be at the forefront of health system transformation in order to promote value, but medical trainees and early career physicians-who have an increasing interest and knowledge in high value care-often lack a structured career path to lead change in this space. Trainees and early career faculty would benefit from practical and concrete guidance throughout their training to ensure they can sustain their passion and leadership in this space as they transition to faculty/independent practice. We outline four career pathways-Education, Care Delivery Research, Quality/Operations Leadership, and Commercial Innovation-that can help trainees translate early interest in high-value care into sustainable professional roles. Creating visible, supported pathways for these careers is essential if health systems hope to retain and empower the next generation of clinicians committed to advancing value.

Authors: Silverstein, W.K., Kerssens, M., Vaassen, S. et al.

Year: 2025

Authors: Christopher Moriates, William K Silverstein, Renato Bandeira de Mello, Lorette Stammen, Brian M Wong

Year: 2023

Authors: Justin Hall, Reza Mirza, James Quinlan, Evan Chong, Karen Born, Brian Wong, Christopher Hillis

Year: 2019

Abstract:
Background: Resident doctors are integral to healthcare delivery in Canada. Engaging residents in resource stewardship is important for professional development, but also as they are drivers of healthcare resource use. To date, no national resident-specific resource stewardship guideline has been developed. Resident Doctors of Canada (RDoC) in collaboration with Choosing Wisely Canada (CWC) sought to develop an evidence-informed, consensus-based list of five recommendations to promote resource stewardship.                  

Methods: RDoC convened a taskforce with diverse geographic and specialty representation to develop candidate recommendations targeting resident resource stewardship behaviours using a consensus-based process, supported by a literature review. Residents across the country provided feedback on the candidate recommendations via an online questionnaire. The taskforce used this feedback to finalize the list.

Results: The taskforce prepared 28 candidate recommendations for consideration. A detailed literature review and consensus process narrowed this list to 12 candidate recommendations for consultation. A total of 754 residents (754/10,068 residents = 7.5%) representing all provinces and levels of residency training reviewed and ranked the candidate recommendations. The highest-ranked recommendations comprised the final list.

Conclusion: Resident doctors are willing and able to demonstrate leadership in advancing resource stewardship by the development of a national resident-specific list of Choosing Wisely Canada recommendations.

Authors: Karen B Born, Christopher Moriates, Victoria Valencia, Marlou Kerssens, Brian M Wong

Year: 2019

Abstract:
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.

Authors: Anand Lakhani, Elliot Lass, William K Silverstein, Karen B Born, Wendy Levinson, Brian M Wong

Year: 2016

Abstract:
Problem: Physician behaviors that promote overuse of health care resources develop early in training, and the medical education environment helps foster such behaviors. The authors describe the development of a Choosing Wisely list for medical students aimed at helping to curb overuse.

Approach: The list was developed in 2015 by Choosing Wisely Canada (CWC) in partnership with the Canadian Federation of Medical Students and the Fédération médicale étudiante du Québec, which together represent all medical students in Canada. CWC convened a student-led taskforce to develop recommendations targeting medical student behaviors with respect to resource stewardship practices. Students at all 17 Canadian medical schools were consulted via an online questionnaire to solicit feedback on a list of 10 candidate recommendations. The taskforce used this student feedback in finalizing the list.

Outcomes: The final list of “Six Things That Medical Students and Trainees Should Question” highlights both behaviors students should avoid (e.g., “Don’t suggest ordering the most invasive test before considering other less invasive options”) and behaviors related to aspects of medical training that may promote overuse, such as the hierarchical nature of clinical supervision (e.g., “Don’t hesitate to ask for clarification on tests, treatments, or procedures that you believe may be ordered inappropriately”). Based on student requests for illustrative examples, clinical vignettes were developed.

Next Steps: This list highlights medical student behaviors and aspects of the academic environment that drive overuse. It is also relevant to faculty, whose behaviors and supervision practices influence trainees.