A learner-driven, longitudinal model for high-value care education: early outcomes from the STARS program

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INTRODUCTION: Attitudes and clinical norms are shaped during medical training. Evidence from high-value care education suggests early exposure influences long-term practice patterns, making it an ideal target for curricula interventions. STARS (Students and Trainees Advocating for Resource Stewardship) is a learner-driven programme developed by Choosing Wisely Canada in 2015 and subsequently adopted in the USA. It exposes medical students to high-value care principles and activates them as change agents. We evaluated perceived sustained influence of the US STARS programme on attitudes, behaviours and professional development among medical students. METHODS: We conducted a mixed-methods programme evaluation of approximately 20% of participants from the first six U.S. cohorts (n=579; 2018-2023). Participants completed an anonymous retrospective pre-post survey assessing familiarity with healthcare value concepts and STARS' perceived influence. They also submitted annotated CVs reviewed for scholarly activities attributed to programme participation. Survey data were analysed using descriptive statistics. RESULTS: Ninety-four of 118 invited participants (80% response rate) completed both components. Participants reported that STARS influenced how they consider healthcare costs in clinical decision-making, discuss medical overuse with peers and appreciate the impact of costs on patients. Many attributed subsequent leadership activities and scholarly output to their participation, including quality improvement projects, peer-reviewed publications and locally implemented educational initiatives. CONCLUSION: This evaluation highlights the potential of learner-driven, longitudinal models such as STARS to foster durable engagement with high-value care education and catalyse professional development among medical trainees.

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