Article Figures & Tables
Tables
- Table 1: Key elements of Students and Trainees Advocating for Resource Stewardship campaign
Element Description Capacity-building activities and resources STARS Leadership Summit 1-day meeting bringing together 2 student representatives from each medical school that equipped students with knowledge about resource stewardship as well as leadership, advocacy and communication skills to support implementation of local student-led Choosing Wisely Canada initiatives. "Six things medical students and trainees should question" Choosing Wisely Canada list for medical education endorsed by CFMS and FMÉQ and made available to all STARS students through the Choosing Wisely Canada website. Community-building activities and resources Conference calls Teleconferences every 2 mo to provide STARS students with a forum to share ideas and ask the national student community for advice related to their initiatives. Facebook group Private Facebook group to allow STARS students to stay in contact with each other and share resources related to their initiatives. Students could also post photographs of STARS events at their schools to showcase their initiatives and successes to other STARS students. Shared Google document Shared Google Doc created by 1 of the STARS students to provide students with a summary of ongoing STARS activities at each school across Canada. Students updated this document with their planned and completed initiatives, resources, and tips for success and lessons learned. Collaboration through STARS community of practice Outside of the conference calls, Facebook group and Google Doc, some STARS students worked collaboratively with students from other schools on common initiatives. These included 1-on-1 interactions and group interactions via videoconference (i.e., group Skype calls). National medical student organizations (CFMS, FMÉQ) Integration of Choosing Wisely Canada principles into FMÉQ Charter, approval and publication of a CFMS Choosing Wisely Position Paper, and engagement of CFMS and FMÉQ liaison representatives to provide ongoing endorsement of the STARS program and student initiatives. School-based activities and resources Other medical students Local medical students were recruited by STARS students to help plan and implement local STARS initiatives. Faculty mentor/advisor Faculty mentor/advisor to mentor STARS students locally and support their change efforts. Some students were able to identify a faculty mentor themselves. For students without a faculty mentor, Choosing Wisely Canada reached out to its network of Choosing Wisely Canada clinical leads to identify faculty who could support student efforts locally. Medical school leadership Deans and department chairs at each medical school provided support to STARS students attempting to navigate the process of curricular change. Note: CFMS = Canadian Federation of Medical Students, FMÉQ = Fédération médicale étudiante du Québec, STARS = Students and Trainees Advocating for Resource Stewardship.
Initiative No. (%) of medical schools Description Curriculum change Planned 6 (35) STARS students embarked on planning curricular changes through a variety of different activities, including reaching out to educational leaders (i.e., vice deans, curricular leads) and undergraduate medical education curriculum committees, reviewing course content to identify opportunities to integrate resource stewardship content, and carrying out formal (e.g., surveys, end-of-session feedback) and informal (e.g., informal conversations) assessment of students' needs to ascertain their perceptions regarding learning about resource stewardship. Implemented 4 (24) Curricular changes varied among schools, with some seeking to make changes to current materials and others hoping to introduce entirely new learning activities. These changes involved the inclusion of resource stewardship education into small-group learning, such as problem-based learning and case-based learning, didactic lectures and clinical skills sessions. Needs assessment 8 (47) Students surveyed and held informal focus groups with their classmates to determine their current level of knowledge regarding Choosing Wisely Canada and resource stewardship. These were independent from needs-assessment activities tied to curriculum planning. Interest group Planned 4 (24) Interest groups were often in the planning stages because the students started their work after the November Leadership Summit, and most schools require interest group proposals to be submitted by October. However, 4 schools have confirmed they will establish a student Choosing Wisely Canada interest group in the upcoming academic year. Implemented 2 (12) Key activities include organizing guest speaker sessions, Choosing Wisely Canada presentations and partnering with other groups with overlapping areas of interest, such as the Students for Antimicrobial Stewardship interest group. Campaign week Implemented 4 (24) Campaign-week activities differed among the various schools. Most decided to hold guest speaker sessions, raise awareness through social media (blog, Facebook, Twitter) and have in-class activities such as trivia contests. A few schools in 1 province decided to work together on a provincial Choosing Wisely Canada campaign week. Awareness-building activities Implemented 4 (24) Students published items related to Choosing Wisely Canada and resource stewardship on social media and in student journals/newsletters and blogs, and also presented at provincial medical student conferences. Special presentation on resource stewardship Implemented 6 (35) Presentations organized by the students outside of the formal curriculum included talks about Choosing Wisely Canada by physicians with first-hand experience, a half-day resource stewardship conference and a session on how to be mindful of resources in clinical practice. Journal club Implemented 2 (12) Journal clubs organized by students involved the critical appraisal of research related to resource stewardship in clinical practice. One school organized a stand-alone activity, and another partnered with an existing journal club series and recommended an article related to resource stewardship for discussion. Other Implemented 3 (18) Advocacy-related activities such as monthly meetings with the dean and Medical Society, and attending lobby days. Note: STARS = Students and Trainees Advocating for Resource Stewardship.
- Table 3: Students' perceptions of facilitators of student-led initiatives and the usefulness of program elements of the Students and Trainees Advocating for Resource Stewardship campaign
Theme Student perception Representative quote Elements perceived to be extremely helpful in facilitating students' success Leadership Summit All students attended Leadership Summit, and most thought it was crucial to their success
Workshops on leadership, advocacy and communication were essential to developing skills required to succeed as part of STARS program
Some students felt that less time should have been spent on building STARS mission statement, and more time listening to speakers and attending workshops"[The leadership summit] gave structure to the group … there were a lot of workshops in the introduction by [Choosing Wisely Canada staff] as to what the focus of the campaign was, and this was really helpful to determine what direction we wanted to go in terms of resource stewardship." (School 3) Conference calls Most students attended conference calls every 2 mo with Choosing Wisely Canada staff and other STARS students
Calls were a great way to obtain high-level overview of activities planned at other schools and to seek advice from larger STARS community and central Choosing Wisely Canada team
Some students commented that the timing of calls during the day made it difficult to attend
Students also felt that calls could have been structured with clearer objectives"It was a good hour-long investment where you could learn a snapshot of what was going on, to tell what you were doing, and then potentially get help if you needed, and I thought that was really effective". (School 4) Collaboration through pan-Canadian STARS network Most students interacted with national STARS student network and found the interaction to be very valuable
Students shared resources, provided peer-feedback and advice to others encountering common challenges, and collaborated on interschool activities (provincial campaign week, surveys)"They didn't want it just be that 1 conference and go off and do your own thing; they wanted to have that connection. I felt the community of practice was good." (School 8) Elements perceived to be helpful facilitators but not consistently accessible or available to students Faculty mentor/advisor About half of the students worked closely with a faculty member and found his or her support to be quite helpful
Faculty members helped by providing advice and guidance, advocating for proposed changes and connecting STARS students with local stakeholders
Students who did not interact as closely with faculty leads at their home institution wanted this support but had challenges scheduling meetings owing to faculty unavailability, or had trouble engaging an actual lead at their school
Other students commented that they were not certain what the faculty lead's role might be in helping with their initiative"Our faculty mentors have essentially pushed our curricular change. It's been great to have an ally who is an MD faculty". (School 4)
"It's hard to find a mentor on your own ... somebody ... you can ask all these questions and bother them." (School 12)Other medical students Some students found it helpful to engage other interested students at their medical school to divide the workload associated with planning and implementing STARS initiatives
Local medical students helped to organize and set up events and engage other classmates, and provided insight on the upper years of medical school for STARS students in preclerkship"The workload of enacting curricular change is significant, and having 2 people, 1 of whom entered clerkship soon after the STARS conference, was a little bit difficult to make all of the changes that we want to happen, so I was really happy that we were able to bring in other motivated students." (School 4) Elements seen as "nice to have" but not perceived to be critical facilitators of overall students' success Facebook group All the students were part of Facebook group but did not perceive that the information shared in the group advanced their local initiatives in a meaningful way
Students appreciated the opportunity to receive updates on other STARS initiatives and enjoyed seeing photographs of successful events
Many students thought Facebook group was not used to its full potential because it was mostly used for passive information sharing and some of the information had already been disseminated through other methods (email, conference calls)
Students would have preferred more active collaboration using the Facebook group
Some students mentioned that they do not used Facebook as much as they had in the past"It was useful to be connected with other students, but I wish it was used for more discussion, and I guess it is hard to … I think it is better for planning or if they put up resources they used ... I know also people put up pictures of things like that. If it was used more like that, I think it would have been more useful ... to keep students all on the same page about what was happening across the different universities. It wasn't fully utilized." (School 1) Shared Google document Most students posted information related to their STARS initiatives on the shared Google Doc at the beginning, but only a small proportion found it to be useful
Main challenge was that students did not routinely update the information on the Google Doc"I guess I can say initially it was quite nice to be able to list all the initiatives as well as faculty names as it was really organized, but I don't know what happened after that; there wasn't really any follow-up." (School 16) Note: STARS = Students and Trainees Advocating for Resource Stewardship.
Theme; subtheme Representative quote Students limited as change agents Multiple competing priorities "[A limitation was] our own time because we obviously have to study medicine … whilst undertaking curricular change." (School 4) Difficult to change a curriculum that student has not yet participated in "Being in first year … I don't have an understanding of what school is like for third and fourth years, so personally trying to do advocacy projects for curricular change and stuff like that is difficult for me to push in third and fourth year." (School 17) Hierarchy in medical education (medical students at bottom) "We are medical students, and we don't have the influence required for curricular change." (School 5) Curricular change is complex Competing curricular demands "There are a lot of different interest groups trying to get a say in the curriculum, so it is hard at this particular moment to kind of put our voices forward … we really need to vouch for why resource stewardship might be more important than [other special interest topics]" (School 5) Undergraduate medical education curriculum renewal/reform "I think people are a bit annoyed when you ask for yet another change, and [our medical school] is already dealing with the accreditation issue. So there are certain things that are higher priorities for them." (School 14) Structural barriers Policies and procedures "The Choosing Wisely campaign and the STARS conference was after the deadline to apply to the interest group people at [our school's] medical student society. … I plan on applying for actual status in the next application for interest groups." (School 14) Logistics and local resources "If you don't book your rooms for the whole year in September or October … we weren't really able to host any events ... in terms of speakers and stuff because we couldn't get a room at the school." (School 17)
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