Have you ever had a medical test or procedure and wondered whether it was really necessary? Millions of people do. Some of these procedures do nothing to improve health; others may actually be harmful. All are expensive. A new program called “Choosing Wisely STARS” (Students and Trainees Advocating for Resource Stewardship) seeks to teach first-year medical students to assess the value of every procedure, test, and surgery more effectively. The goal is to help future physicians improve health outcomes for patients while lowering costs.
The Ohio State University College of Medicine is participating in the program, which involves 50 students from 25 medical schools across the country. Dan Clinchot, Vice Dean for Education, serves as Ohio State’s Choosing Wisely leader. “Having an Ohio State team of students chosen for the STARS program will enable them to be taught the tenets of value-based care and bring what they are learning to help create positive change in central Ohio," he noted.
The U.S. Choosing Wisely STARS program mirrors a successful Canadian program begun in 2015. The U.S. program is supported by the Josiah Macy Jr. Foundation and the ABIM Foundation, a nonprofit organization of the American Board of Internal Medicine. It was launched with a one-day conference at the University of Texas at Austin’s Dell Medical School on Dec. 2.
Ohio State’s student participants are Mukund Mohan and Victoria Alexander. Mohan is excited about the initiative because of his participation as a research technician in a similar program at the Wayne State University Department of Emergency Medicine. He detailed one example: “The common procedure to look for bleeding in the brain after head injuries is a CT scan, but those pose the risk of exposure to radiation. My mentor there, Dr. Philip Levy, and his team were studying to see whether we could use a Quantitative EEG instead--a low-cost, noninvasive procedure that analyzes electrical brain activity. So it was a question of balancing the risk of a possible brain bleed with the risk of exposure to radiation.”
Victoria Alexander gained first-hand experience in the concept of value-based medicine at a hospital in rural Ecuador while doing research for her master’s degree. “I witnessed patients having to choose between paying their rent and having a surgery, supplying food for the family or seeking care for a chronic cough,” she explained. I know similar problems exist in our country, as well, and I hope to be on the forefront of approaching these challenges.”
At the Choosing Wisely conference, students learned how to create local and regional change in areas of overuse or waste. The next goal was to translate this knowledge to drive change at their medical schools to improve the value of patient care as they progress through their training.
Kim Tartaglia, MD, Associate Clinical Professor in Hospital Medicine, is faculty mentor for Ohio State’s Choosing Wisely program. She assists student participants with any initiatives or projects on high-value care. “At OSU, we have been teaching high-value care to residents and students for the last five years,” she said, “but there is a significant ‘hidden curriculum’ because doctors and health professionals had previously not been taught to think about healthcare costs or value. By empowering students to think and act about value in healthcare, we are changing the culture from the ground up.”
Conference participants were encouraged to share stories of successes and challenges. They were also invited to join the ABIM Foundation’s existing Teaching Value in Health Care learning network (abimfoundation.org). The challenge is for the students to launch their own local programs and Choosing Wisely initiatives, supported by communities across the country.