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Shah D, Behravan N, Al-Jabouri N, Sibbald M. Incorporating equity, diversity and inclusion (EDI) into the education and assessment of professionalism for healthcare professionals and trainees: a scoping review. BMC MEDICAL EDUCATION 2024; 24:991. [PMID: 39261856 PMCID: PMC11391843 DOI: 10.1186/s12909-024-05981-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 09/03/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Current definitions of professionalism for healthcare trainees often lack equity, diversity and inclusion (EDI) in the expectations and assessment of professionalism. While professionalism teaching is incorporated in healthcare training, equity-deserving groups still experience discrimination. This scoping review investigates the literature to understand how EDI and associated domains of cultural humility, and advocacy can be incorporated in healthcare trainees' education and assessment of professionalism. METHODS The Arksey and O'Malley framework was applied to this scoping review. MEDLINE, Embase & PsychINFO were searched up to March 2023, with terms surrounding health professionals, professionalism, EDI, cultural humility, and advocacy. Titles and abstracts (n = 3870) and full-texts (n = 140) were independently screened by two reviewers. Articles were included if they focused on EDI, cultural humility, or advocacy among healthcare students/trainees, and had outcomes related to professionalism. Articles lacking discussion of professionalism as an outcome were excluded. Themes were generated by mutual discussion. Risk of bias was assessed using the Cote et al. and Medical Education Research Study Quality Instrument (MERSQI) tools. RESULTS 48 articles underwent thematic analysis. Studies investigated the disciplines of medicine, nursing, social work, physiotherapy, and dentistry. Most studies were qualitative in methodology (n = 23). Three themes emerged: (1) EDI-related interventions are associated with improved professionalism of healthcare trainees/workers (n = 21). Interventions employed were either an EDI-associated educational course (n = 8) or an exchange program to promote EDI competencies among trainees (n = 13). (2) Trainee definitions and perceptions of professionalism include themes related to EDI and cultural humility (n = 12). (3) Current standards of professionalism are perceived as non-inclusive towards historically-marginalized populations (n = 15). Literature investigating advocacy as it relates to professionalism is limited. CONCLUSION This review identified that core EDI principles and its associated domains of cultural humility and advocacy are often viewed as integral to professionalism. These findings create a strong impetus to incorporate EDI principles within professionalism frameworks in healthcare education. Future research should employ standardized tools for professionalism assessment to provide more conclusive evidence. Incorporating patient perspectives of professionalism can inform actionable recommendations for fostering inclusive healthcare environments.
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Affiliation(s)
- Darsh Shah
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nima Behravan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nujud Al-Jabouri
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Matthew Sibbald
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
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Cagande C, Aswad Y, Ismail A, Lewis-de Los Angeles CP, Fletcher K, Hunt J. Preparing Trainees for Public Health Advocacy Through Community Partnerships. Child Adolesc Psychiatr Clin N Am 2024; 33:447-456. [PMID: 38823816 DOI: 10.1016/j.chc.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
This article reviews the existing literature related to medical training in public advocacy and provides the reader with several training examples to consider in a child and adolescent psychiatry fellowship or in combined training programs. Advocacy training embedded within community, forensic, integrated care, school, and many other experiences throughout training provides the skills and tools that the trainee will use in the future when they practice in any setting. This comprehensive training approach aligns with the evolving landscape of child and adolescent mental health where a deep commitment to public health and advocacy is increasingly essential.
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Affiliation(s)
- Consuelo Cagande
- CHOP/Department of Child and Adolescent Psychiatry and Behavioral sciences, Hub for Clinical Collaboration, 3500 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Yvorn Aswad
- Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA
| | - Aateqa Ismail
- CHOP/Department of Child and Adolescent Psychiatry and Behavioral sciences, Hub for Clinical Collaboration, 3500 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - C Paula Lewis-de Los Angeles
- Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA
| | - Katrina Fletcher
- CHOP/Department of Child and Adolescent Psychiatry and Behavioral sciences, Hub for Clinical Collaboration, 3500 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Jeffrey Hunt
- Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA
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Willing L, Schreiber J. Using Advocacy to Address the Crisis of Children's Mental Health. Child Adolesc Psychiatr Clin N Am 2024; 33:319-330. [PMID: 38823806 DOI: 10.1016/j.chc.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
Children and youth in the United States are experiencing a mental health crisis that predates the COVID-19 pandemic. Child and adolescent psychiatrists have the knowledge and skillset to advocate for improving the pediatric mental health care system at the local, state, and federal levels. Child psychiatrists can use their knowledge and expertise to advocate legislatively or through regulatory advocacy to improve access to mental health care for youth. Further, including advocacy education in psychiatry and child psychiatry graduate medical education would help empower child psychiatrists to make an impact through their advocacy efforts.
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Affiliation(s)
- Laura Willing
- Children's National Hospital and George Washington University School of Medicine, 6833 4th Street NW Washington, DC 20012, USA.
| | - Justin Schreiber
- University of Pittsburgh Medical Center, Western Psychiatric Hospital, UPMC Children's Hospital of Pittsburgh, Lawrenceville Medical Building, 4117 Penn Avenue, 3rd Floor- 3111, Pittsburgh, PA 15224, USA
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Brown A, Wall TN, Pratt G, Talen MR, O'Grady C, Reitz R. Even one voice: Teaching legislative advocacy as a core competency in family medicine. Int J Psychiatry Med 2024; 59:424-431. [PMID: 37469126 DOI: 10.1177/00912174231190136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Credentialing bodies increasingly focus on advocacy as a competency to be developed by physicians during residency. The skills of advocacy are especially important with the increased attention on social determinants of health, as restrictive state and federal health policy decisions gain widespread attention in the national news media. This movement is reflected in the ACGME's recently revised statement on the training mission of family medicine residencies with the most recent update of milestones, which identifies advocacy as a core competency. Additionally, the major family medicine organizations and governing bodies all similarly identify advocacy as an important professional responsibility for family physicians. Advocacy is a broad term that can be applied across a range of settings and scenarios. For the purposes of this paper we focus primarily on legislative advocacy as a specific area for growing curricular emphasis in family medicine residency programs.
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Affiliation(s)
- Alexander Brown
- NH Dartmouth Family Medicine Residency, Concord Hospital Family Health Center, Concord, NH, USA
| | - Terri N Wall
- Family Medicine, St Vincent's HealthCare, Jacksonville, FL, USA
| | - Grace Pratt
- Great Plains Family Medicine, INTEGRIS Health Inc, Oklahoma, OK, USA
| | - Mary R Talen
- Family Medicine, Ascension Health Resurrection Medical Center, Chicago, IL, USA
- Family Medicine¸ AMITA Health Resurrection Medical Center Chicago Family Medicine Residency, Chicago, IL, USA
| | - Clare O'Grady
- NH Dartmouth Family Medicine Residency, Concord Hospital Family Health Center, Concord, NH, USA
| | - Randall Reitz
- St. Mary's Family Medicine Residency, Grand Junction, CO, USA
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Puschel K, Thompson B, Rioseco A, Leon A, Goic C, Fuentes I, Vescovi Z. Cancer advocacy in residency education: From principles to competencies. J Cancer Policy 2024; 40:100470. [PMID: 38479645 DOI: 10.1016/j.jcpo.2024.100470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION The global cancer burden is increasing. Current global evidence indicates there will be a 47% rise of cancer cases for the period 2020-2040. The cancer rate differential also is evident within countries and regions. Efforts have been used to reduce the health disparities; however, the inequity prevails. One potential way to help reduce the disparity is through advocacy by physicians. METHODS Two recent systematic review articles on advocacy among physicians note that physicians are unlikely to be taught advocacy in medical education, and also note there are no advocacy competencies or skill sets that are either taught or valued in medical education. We explore literature and develop a model to understand the components of advocacy in medical education, specifically in resident training. We follow the model's main components by examining principles of advocacy, relevant domains of advocacy, and competencies and values for advocacy education. RESULTS Four ethical principles of advocacy education are identified: beneficence, non-maleficence, autonomy, and justice. These principles must be applied in meaningful, culturally sensitive, respectful, and promotion of the well-being ways. Three domains are identified: the practice domain (provider-patient interaction), the community domain (provider-community collaboration), and the health policy domain (the larger social environment). Advocacy occurs differently within each domain. Finally, competencies in the form of knowledge, skills, and values are described. We present a table noting where each competency occurs (by domain) as well as the value of each knowledge and skill. POLICY SUMMARY The significance of including advocacy instruction in medical education requires a change in the current medical education field. Besides valuing the concept of including advocacy, principles, domains, and competencies of inclusion are critical. In summary, we encourage the inclusion of advocacy education in resident medical programs so physicians become competent medical providers at diverse levels of society.
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Affiliation(s)
- Klaus Puschel
- Department of Family and Community Medicine, School of Medicine, Universidad Católica de Chile, Chile; Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile.
| | - Beti Thompson
- Public Health Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Andrea Rioseco
- Department of Family and Community Medicine, School of Medicine, Universidad Católica de Chile, Chile; Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile
| | - Augusto Leon
- Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile; Department of Surgical Oncology, School of Medicine, Universidad Católica de Chile, Chile
| | - Carolina Goic
- Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile
| | - Isabella Fuentes
- Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile
| | - Zdenka Vescovi
- Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile
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Burra TA, Soong C, Wong BM. Taking action on inequities: a structural paradigm for quality and safety. BMJ Qual Saf 2024; 33:351-353. [PMID: 38688709 DOI: 10.1136/bmjqs-2023-017027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Affiliation(s)
- Tara A Burra
- Department of Psychiatry, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Christine Soong
- General Internal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Brian M Wong
- Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Burnett JR, De Lima B, Wang ES, McGarry K, Kim DI, Kisielewski M, Manley K, Desai SS, Eckstrom E, Henry TL. How Are We Teaching Advocacy? A National Survey of Internal Medicine Residency Program Directors. J Gen Intern Med 2024:10.1007/s11606-024-08753-3. [PMID: 38710862 DOI: 10.1007/s11606-024-08753-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/29/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Although internal medicine (IM) physicians accept public advocacy as a professional responsibility, there is little evidence that IM training programs teach advocacy skills. The prevalence and characteristics of public advocacy curricula in US IM residency programs are unknown. OBJECTIVES To describe the prevalence and characteristics of curricula in US IM residencies addressing public advocacy for communities and populations; to describe barriers to the provision of such curricula. DESIGN Nationally representative, web-based, cross-sectional survey of IM residency program directors with membership in an academic professional association. PARTICIPANTS A total of 276 IM residency program directors (61%) responded between August and December 2022. MAIN MEASUREMENTS Percentage of US IM residency programs that teach advocacy curricula; characteristics of advocacy curricula; perceptions of barriers to teaching advocacy. KEY RESULTS More than half of respondents reported that their programs offer no advocacy curricula (148/276, 53.6%). Ninety-five programs (95/276, 34.4%) reported required advocacy curricula; 33 programs (33/276, 12%) provided curricula as elective only. The content, structure, and teaching methods of advocacy curricula in IM programs were heterogeneous; experiential learning in required curricula was low (23/95, 24.2%) compared to that in elective curricula (51/65, 78.5%). The most highly reported barriers to implementing or improving upon advocacy curricula (multiple responses allowed) were lack of faculty expertise in advocacy (200/276, 72%), inadequate faculty time (190/276, 69%), and limited curricular flexibility (148/276, 54%). CONCLUSION Over half of US IM residency programs offer no formal training in public advocacy skills and many reported lack of faculty expertise in public advocacy as a barrier. These findings suggest many IM residents are not taught how to advocate for communities and populations. Further, less than one-quarter of required curricula in public advocacy involves experiential learning.
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Affiliation(s)
- Joel R Burnett
- Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA.
| | - Bryanna De Lima
- Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA
| | - Emily S Wang
- UT Health San Antonio Long School of Medicine, San Antonio, TX, USA
| | - Kelly McGarry
- Alpert Medical School at Brown University, Providence, RI, USA
| | - Daniel I Kim
- University of California, Riverside School of Medicine, Riverside, CA, USA
| | | | - Kelsi Manley
- Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA
| | - Sima S Desai
- Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA
| | - Elizabeth Eckstrom
- Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA
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Dhatt A, Fazelipour M, Sun T, Nemir A, Wilbur K. Health advocacy: A gulf between instruction and practice. CURRENTS IN PHARMACY TEACHING & LEARNING 2024; 16:335-342. [PMID: 38594170 DOI: 10.1016/j.cptl.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Systematic ways to teach health advocacy, an educational outcome for pharmacy graduates, is lacking. We developed a workshop to facilitate understanding and application of a novel structured framework for health advocacy and explored how pharmacy students enacted opportunities for health advocacy during subsequent outpatient experiential training. EDUCATIONAL ACTIVITY AND SETTING A two-hour workshop was introduced for year 2 students in 2019. Its content was organized around a health advocacy framework. With patient and faculty facilitators, students worked through examples characterized into the framework's four quadrants: 1) shared advocacy "with patients" at the individual- or 2) systems-level and 3) directed advocacy "for patients" at the individual-or 4) systems-level. We then conducted a longitudinal diary study asking pharmacy students (N = 23) to reflect on opportunities to practice health advocacy skills in community pharmacy practice. A systematic, multi-coder reflexive thematic analysis of diary entries was employed. FINDINGS Pharmacy students did not express a fulsome view of patient health advocacy and mischaracterized self-reported practice examples into inappropriate categories of the health advocacy framework. Most overemphasized usual pharmacist care as acts of health advocacy. No systems-level activities were undertaken, although isolated episodes of shared advocacy with patients were identified. SUMMARY Lasting impacts of a health advocacy workshop in our pharmacy curriculum were not widely apparent. While longer training periods in community pharmacy practice may yield more opportunities to develop and enact this role, gaps in student conceptualization of health advocacy and inabilities to practically observe and exercise system-level advocacy are ultimately problematic for patient care.
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Affiliation(s)
- Amninder Dhatt
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2508 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Mojan Fazelipour
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2508 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Tom Sun
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2508 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada
| | - Arwa Nemir
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2508 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Kerry Wilbur
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2508 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
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Anderson HL, Lewis N, Rezet B. A Qualitative Study of Resident Advocacy Work. Pediatrics 2024; 153:e2023061590. [PMID: 38361480 DOI: 10.1542/peds.2023-061590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Advocacy is a critical component of pediatric training and practice. Pediatric resident advocacy experiences include skill development and real-world projects, but little is known about how pediatric residents participate in advocacy. Without this knowledge, educators run the risk of underpreparing residents for the full scope of advocacy work. This study sought to investigate how residents participate in advocacy by characterizing their projects using an evidence-informed conceptual framework and describing the unique lessons were learned by the residents. METHODS The authors used principles of thematic analysis to interrogate existing documents derived from pediatric residents from 2013 to 2021 at 1 institution. They purposefully sampled and deidentified project proposals and written reflections. Using a constant comparative method, they created codes. Codes, connections between codes, and findings were refined by discussion. RESULTS Residents demonstrated 4 different types of advocacy: some residents participated in directed agency or activism and others focused on shared agency or activism. Residents reflected on different learning experiences; residents who participated in shared forms of advocacy learned skills such as "Partnering," "Evaluating," and "Planning." Residents who were involved in directed forms of advocacy shared lessons on "Leading," "Presenting," and "Intervening." Advocacy work also changed over time: in later projects (2016-2021) residents took ownership of the role of "advocate"; social and political climate was salient in reflections. CONCLUSIONS Pediatric residents advocate through shared activism and agency and directed activism and agency. Educators should recognize, support, and supplement the experiences of residents as they participate in different types of advocacy.
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Affiliation(s)
- Hannah L Anderson
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine
| | - Noreena Lewis
- Community Pediatrics and Advocacy Program
- Pediatrics Residency Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Beth Rezet
- Community Pediatrics and Advocacy Program
- Pediatrics Residency Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Boodoo R, Lagman JG, Eisele C, Saunders EFH. Highlighting Areas for Gun Violence Advocacy, as a Part of Medical Education in the USA. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:466-468. [PMID: 37651037 DOI: 10.1007/s40596-023-01846-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Ramnarine Boodoo
- Pennsylvania State University College of Medicine, Hershey, PA, USA.
| | | | - Caroline Eisele
- Pennsylvania State University College of Medicine, Hershey, PA, USA
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Agrawal N, Lucier J, Ogawa R, Arons A. Advocacy Curricula in Graduate Medical Education: an Updated Systematic Review from 2017 to 2022. J Gen Intern Med 2023; 38:2792-2807. [PMID: 37340255 PMCID: PMC10507002 DOI: 10.1007/s11606-023-08244-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/15/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Advocacy is an integral component of a physician's professional responsibilities, yet efforts to teach advocacy skills in a systematic and comprehensive manner have been inconsistent and challenging. There is currently no consensus on the tools and content that should be included in advocacy curricula for graduate medical trainees. OBJECTIVE To conduct a systematic review of recently published GME advocacy curricula and delineate foundational concepts and topics in advocacy education that are pertinent to trainees across specialties and career paths. METHODS We conducted an updated systematic review based off Howell et al. (J Gen Intern Med 34(11):2592-2601, 2019) to identify articles published between September 2017 and March 2022 that described GME advocacy curricula developed in the USA and Canada. Searches of grey literature were used to find citations potentially missed by the search strategy. Articles were independently reviewed by two authors to identify those meeting our inclusion and exclusion criteria; a third author resolved discrepancies. Three reviewers used a web-based interface to extract curricular details from the final selection of articles. Two reviewers conducted a detailed analysis of recurring themes in curricular design and implementation. RESULTS Of 867 articles reviewed, 26 articles, describing 31 unique curricula, met inclusion and exclusion criteria. The majority (84%) represented Internal Medicine, Family Medicine, Pediatrics, and Psychiatry programs. The most common learning methods included experiential learning, didactics, and project-based work. Most covered community partnerships (58%) and legislative advocacy (58%) as advocacy tools and social determinants of health (58%) as an educational topic. Evaluation results were inconsistently reported. Analysis of recurring themes showed that advocacy curricula benefit from an overarching culture supportive of advocacy education and should ideally be learner-centric, educator-friendly, and action-oriented. DISCUSSION Combining core features of advocacy curricula identified in prior publications with our findings, we propose an integrative framework to guide design and implementation of advocacy curricula for GME trainees. Additional research is needed to build expert consensus and ultimately develop model curricula for disseminated use.
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Affiliation(s)
- Nupur Agrawal
- Division of Internal Medicine and Pediatrics, Department of Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA USA
| | - Jessica Lucier
- Palliative Care Program, Division of General Internal Medicine & Health Services Research, Department of Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA USA
| | - Rikke Ogawa
- UCI Libraries, University of California Irvine, Irvine, CA USA
| | - Abigail Arons
- Division of General Internal Medicine, Department of Internal Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA USA
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Fazelipour M, Dhatt A, Sun T, Nemir A, Wilbur K. Pharmacy Students Practicing Health Advocate Competency Roles in Workplace-Based Training. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100118. [PMID: 37714657 DOI: 10.1016/j.ajpe.2023.100118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/25/2023] [Accepted: 04/05/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE Health advocacy competency roles are found in the educational outcomes of many health disciplines, yet their development is neglected in the professional curriculum and clinical learning environment. We explored how pharmacy students conceptualize health advocacy through their practice in workplace-based learning and any feedback they receive. METHODS We conducted a longitudinal diary study of Canadian pharmacy students completing Advanced Pharmacy Practice Experiences in hospital and community practices in their graduating year. At pre-determined intervals, 25 students recorded workplace-based activities they recognized as health advocacy and any feedback they received from supervisors, patients, or other staff. Written diary data from 180 records were analyzed by 5 researchers according to inductive content analysis steps and principles. RESULTS Pharmacy student records reflecting health advocacy roles were organized into 5 categories including, (1) disease prevention; (2) health promotion; (3) seamless care; (4) usual pharmacist care; and (5) professional advocacy. Although many activities were consistent with current competency role descriptions, they do not reflect educational outcomes associated with patient- or systems-level support necessary to address socio-political determinants of health. Although Advanced Pharmacy Practice Experience in training evaluation reports included scores for items related to health advocacy competency, few students confirmed receiving specific written or verbal feedback. CONCLUSION Pharmacy students construct health advocacy roles in workplace-based training through biomedical-oriented practices with little direct input offered by supervisors. Pharmacy educational outcomes require contemporary updates to health advocacy competency descriptions which offer examples for practical enactment at system-level and recommendations for feedback and assessment.
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Affiliation(s)
- Mojan Fazelipour
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Amninder Dhatt
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Tom Sun
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Arwa Nemir
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Kerry Wilbur
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada.
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Neubeck L, Galbraith M, Drossart I, Mindham R. The essential role of patients in advocacy and policy. Eur Heart J 2023:ehad312. [PMID: 37317798 DOI: 10.1093/eurheartj/ehad312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Affiliation(s)
- Lis Neubeck
- Sighthill Court, Edinburgh Napier University, Edinburgh EH11 4BN, UK
| | | | - Inga Drossart
- ESC Patient Forum, Sophia Antipolis, France
- European Society of Cardiology, Sophia Antipolis, France
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Burm S, Cristancho S, Watling CJ, LaDonna KA. Expanding the advocacy lens: using photo-elicitation to capture patients' and physicians' perspectives about health advocacy. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:411-426. [PMID: 36214940 DOI: 10.1007/s10459-022-10162-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 09/03/2022] [Indexed: 05/11/2023]
Abstract
Heath advocacy (HA) remains a difficult competency to train and assess, in part because practicing physicians and learners carry uncertainty about what HA means and we are missing patients' perspectives about the role HA plays in their care. Visual methods are useful tools for exploring nebulous topics in health professions education; using these participatory approaches with physicians and patients might counteract the identified training challenges around HA and more importantly, remedy the exclusion of patient perspectives. In this paper we share the verbal and visual reflections of patients and physicians regarding their conceptualizations of, and engagement in 'everyday' advocacy. In doing so, we reveal some of HA's hidden dimensions and what their images uncovered about the role of advocacy in patient care. Constructivist grounded theory guided data collection and analysis. Data was collected through semi-structured interviews and photo-elicitation, a visual research method that uses participant generated photographs to elicit participants knowledge and experiences around a particular topic. We invited patients living with chronic health conditions (n = 10) and physicians from diverse medical and surgical specialties (n = 14) to self-select photographs representing their experiences navigating HA in their personal and professional lives. Both groups found taking photographs useful for revealing the nuanced and circumstantial factors that either enabled or challenged their engagement in HA. While patients' photos highlighted their embodiment of HA, physicians' photos depicted HA as something quite elusive or as a complicated and daunting task. Photo-elicitation was a powerful tool in eliciting a diversity of perspectives that exist around the HA role and the work advocates perform; training programs might consider using visuals to augment teaching for this challenging competency.
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Affiliation(s)
- Sarah Burm
- Continuing Professional Development and Division of Medical Education, Clinical Research Centre, C-104, Dalhousie University, 5849 University Ave, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Sayra Cristancho
- Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Christopher J Watling
- Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Kori A LaDonna
- Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Braverman J, Snyder M. Psychological Predictors of Medical Students' Involvement in Pro Bono. TEACHING AND LEARNING IN MEDICINE 2023; 35:193-205. [PMID: 35290145 DOI: 10.1080/10401334.2022.2043156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
THEORY Medical pro bono, in which medical professionals provide no (or low) cost services, is one approach to addressing unmet healthcare needs. Prior efforts to understand who chooses to take part in pro bono and why they might do so have been primarily atheoretical in their approach. The current investigation focuses on students in medical school and draws on relevant theory and research in psychology to identify predictors of their intentions to engage in medical pro bono service during and after medical school.Hypotheses:Four major approaches to identifying predictors of medical pro bono are examined: the role of demographic variables as predictors of medical pro bono, conceptualizing medical pro bono as a form of volunteerism, viewing medical pro bono as an expression of personality, and medical pro bono as a reflection of role identities and expectations. Each of these approaches can be characterized as being about medical students' individual attributes or aspects of the situation they are in. METHODS A total of 278 medical students from 15 different medical schools in the United States of America completed a web-based survey (8/4/2020-9/22/2020). The students completed measures of pro bono identity and expectations, intentions to engage in medical pro bono activities, prosocial personality, volunteer motivation, exposure to volunteering, general traits of personality, and demographic variables (in this order). We used linear regression analyses to separately predict three measures of intentions (general medical school intentions, intentions toward medical pro bono trips during medical school, and general post medical school intentions). RESULTS The strongest predictors of intentions to engage in medical pro bono were one's identity and expectations related to pro bono. Medical students who had incorporated medical pro bono into aspects of their identity and/or considered medical pro bono to be an expectation indicated higher intentions to engage in medical pro bono work. Conversely, volunteer motivation/exposure, personality, and demographic variables were much weaker predictors of medical pro bono. CONCLUSIONS The findings of the present study have implications for ways that medically oriented volunteering may be increased by individual-level interventions and/or changes in medical education. Individual-level interventions could leverage the importance of identity and expectations to craft persuasive messaging to appeal to identity and expectations as drivers of engagement in medical pro bono. Program level interventions could work toward the institutionalization of medical pro bono by the inclusion/promotion of medical pro bono into the program's co-curricular and/or extracurricular activities.
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Affiliation(s)
- Joshua Braverman
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mark Snyder
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
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16
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LaDonna KA, Kahlke R, Scott I, van der Goes T, Hubinette M. Grappling with key questions about assessment of the Health Advocate role. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:80-89. [PMID: 36998507 PMCID: PMC10042793 DOI: 10.36834/cmej.73878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Introduction Although the CanMEDS framework sets the standard for Canadian training, health advocacy competence does not appear to factor heavily into high stakes assessment decisions. Without forces motivating uptake, there is little movement by educational programs to integrate robust advocacy teaching and assessment practices. However, by adopting CanMEDS, the Canadian medical education community endorses that advocacy is required for competent medical practice. It's time to back up that endorsement with meaningful action. Our purpose was to aid this work by answering the key questions that continue to challenge training for this intrinsic physician role. Methods We used a critical review methodology to both examine literature relevant to the complexities impeding robust advocacy assessment, and develop recommendations. Our review moved iteratively through five phases: focusing the question, searching the literature, appraising and selecting sources, and analyzing results. Results Improving advocacy training relies, in part, on the medical education community developing a shared vision of the Health Advocate (HA) role, designing, implementing, and integrating developmentally appropriate curricula, and considering ethical implications of assessing a role that may be risky to enact. Conclusion Changes to assessment could be a key driver of curricular change for the HA role, provided implementation timelines and resources are sufficient to make necessary changes meaningful. To truly be meaningful, however, advocacy first needs to be perceived as valuable. Our recommendations are intended as a roadmap for transforming advocacy from a theoretical and aspirational value into one viewed as having both practical relevance and consequential implications.
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Affiliation(s)
| | | | - Ian Scott
- University of British Columbia, British Columbia, Canada
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17
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Truong J, Sandhu P, Sheng V, Sadeghi Y, Leung FH, Wright R, Suleman S. Advocacy in community-based service learning: perspectives of community partner organizations. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:90-94. [PMID: 36998499 PMCID: PMC10042788 DOI: 10.36834/cmej.74887] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background Health advocacy is a core competency for physicians, which can be developed through community-based service-learning (CBSL). This exploratory study investigated the experiences of community partner organizations (CPOs) participating in CBSL in the context of health advocacy. Methods A qualitative study was conducted. Nine CPOs at a medical school participated in interviews on topics pertaining to CBSL and health advocacy. Interviews were recorded, transcribed, and coded. Major themes were identified. Results CPOs perceived a positive impact from CBSL through student activities and connecting with the medical community. There was no unifying definition of health advocacy. Advocacy activities varied depending on the individual's role (i.e., CPO, physician, and student), which encompassed providing patient care or services, raising awareness of healthcare issues, and influencing policy changes. CPOs had different perceptions of their role in CBSL from facilitating service-learning opportunities to teaching students in CBSL, while a few desired to be involved in curriculum development. Conclusion This study provides further insight into health advocacy from the lens of CPOs, which may inform changes to health advocacy training and the CanMEDS Health Advocate Role to better align with the values of community organizations. Engaging CPOs in the broader medical education system may improve health advocacy training and ensure a positive bidirectional impact.
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Affiliation(s)
- Judy Truong
- Department of Internal Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Priya Sandhu
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Vanessa Sheng
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Yasamin Sadeghi
- Institute of Medical Science, University of Toronto, Ontario, Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Ontario, Canada
| | - Roxanne Wright
- MD program, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Shazeen Suleman
- Women and Children's Health Program, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Ontario, Canada
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18
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Abstract
Pediatricians are effective advocates to improve the health and well-being of children, yet there are limited avenues by which to pursue academic promotion based on these activities. Drawing on an expanded definition of scholarship, pediatric advocates can use the portfolio format to highlight the quantity, quality, and impact of advocacy activities. True congruence with research and education will only be achieved through recognition and value by institutions and organizations.
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19
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Beers LS, Williams-Willingham MA, Chamberlain LJ. Making Advocacy Part of Your Job: Working for Children in Any Practice Setting. Pediatr Clin North Am 2023; 70:25-34. [PMID: 36402468 DOI: 10.1016/j.pcl.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Effective child health advocacy is an essential strategy to improve child health, and can improve access to equitable care. It can also be professionally rewarding and improve career satisfaction. However, while advocacy has been a part of pediatrics since its origins as a specialty, many barriers to engaging in health advocacy exist which can be challenging to navigate. There are a wide range of organizational practice settings, which are each accompanied by unique strengths and limitations. No matter the practice setting, pediatricians can be effective advocates for child health through leveraging organizational, professional, and community resources and partnerships.
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Affiliation(s)
- Lee Savio Beers
- Child Health Advocacy Institute, Children's National Hospital, 111 Michigan Avenue Northwest, Washington, DC 20010, USA.
| | | | - Lisa J Chamberlain
- Department of Pediatrics, Stanford, School of Medicine, 453 Quarry Road, Mail Code 5459, Stanford, CA 94305, USA
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20
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Earnest M, Wong SL, Federico S, Cervantes L. A Model of Advocacy to Inform Action. J Gen Intern Med 2023; 38:208-212. [PMID: 36323827 PMCID: PMC9629756 DOI: 10.1007/s11606-022-07866-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
The need for effective advocacy on the part of health professionals has never been greater. The recent COVID-19 pandemic has made the connection between human health and social conditions clear, while highlighting the limitations of biomedical interventions to address those conditions. Efforts to increase the frequency and effectiveness of advocacy activities by health professionals have been hampered by the lack of a practical framework to define and develop advocacy competencies among trainees as well as to plan and execute advocacy activities. The authors of this article propose a framework which defines advocacy as occurring across three domains of influence (practice, community, and government) using three categories of advocacy skills (policy, communication, and relationships). When these skills are successfully applied in the appropriate domains of influence, the resulting change falls into three levels: individual, adjacent, and structural. The authors assert that this framework is immediately applicable to a broad variety of health professionals, educators, researchers, organizations, and professional societies as they individually and collectively seek to improve the health and well-being of those they care for.
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Affiliation(s)
- Mark Earnest
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Shale L Wong
- Department of Pediatrics, Eugene S. Farley, Jr. Health Policy Center, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Steve Federico
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, USA.,Denver Health and Hospital Authority, Denver, USA
| | - Lilia Cervantes
- Division of Hospital Medicine, University of Colorado Anschutz Medical, Aurora, USA
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21
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Manze M, Romero D, Kwan A, Ellsworth TR, Jones H. Physician perspectives of abortion advocacy: findings from a mixed-methods study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:7-11. [PMID: 35396323 PMCID: PMC9872227 DOI: 10.1136/bmjsrh-2021-201394] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Our aim was to assess physicians' perspectives of what constitutes abortion advocacy and the skills needed to be effective in their efforts to safeguard legal abortion. METHODS Alumni from a physician training programme for sexual and reproductive health advocacy completed a cross-sectional survey including questions on perceived skills needed for effective advocacy. The research team conducted in-depth interviews (IDIs) with alumni, based on their level of engagement in advocacy. We present descriptive statistics for survey data and themes identified in the interview data using techniques informed by grounded theory. RESULTS Of the survey respondents (n=231), almost a third (28.6%; n=66) felt the most important media skill they learnt was the ability to stay on message. The most important policy skill was communicating effectively with policymakers (47.0%; n=108), followed by distilling evidence for policymakers and laypeople (13.0%; n=30). In the IDIs (n=36), participants reported activities such as media interviews as clear examples of advocacy, but also considered implementing institutional policies and abortion provision to be advocacy. They discussed how individual comfort and capacity for advocacy activities may change over time, given personal and professional considerations. Regardless of the type of activity, physicians valued strategic communication and relationship-building skills. CONCLUSIONS Based on our findings, training programmes that seek to mobilise physician advocates to advance sexual and reproductive health and rights should work with trainees to create a tailored advocacy plan that fits their personal and professional lives and goals. Regardless of the types of advocacy activities physicians focus on, strategic communication may be central in skills-based training.
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Affiliation(s)
- Meredith Manze
- Community Health and Social Sciences, CUNY School of Public Health, New York, New York, USA
| | - Diana Romero
- Community Health and Social Sciences, CUNY School of Public Health, New York, New York, USA
| | - Amy Kwan
- Community Health and Social Sciences, CUNY School of Public Health, New York, New York, USA
| | | | - Heidi Jones
- Department of Epidemiology and Biostatistics, CUNY School of Public Health, New York, New York, USA
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22
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Kyanko KA, Fisher MA, Riddle-Jones L, Chen A, Jetton F, Staiger T, Schwartz MD. National Health Policy Leadership Program for General Internists. J Gen Intern Med 2022; 37:4137-4143. [PMID: 35199260 PMCID: PMC8865497 DOI: 10.1007/s11606-022-07455-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/03/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Early or mid-career physicians have few opportunities to participate in career development programs in health policy and advocacy with experiential and mentored training that can be incorporated into their busy lives. AIM The Society of General Internal Medicine (SGIM) created the Leadership in Health Policy (LEAHP) program, a year-long career development program, to prepare participants with a sufficient depth of knowledge, skills, attitudes, and behaviors to continue to build mastery and effectiveness as leaders, advocates, and educators in health policy. We sought to evaluate the program's impact on participants' self-efficacy in the core skills targeted in the curriculum. SETTING/PARTICIPANTS Fifty-five junior faculty and trainees across three scholar cohorts from 2017 to 2021. PROGRAM DESCRIPTION Activities included workshops and exercises at an annual meeting, one-on-one mentorship, monthly webinars and journal clubs, interaction with policy makers, and completion of capstone projects. PROGRAM EVALUATION Self-administered, electronic surveys conducted before and following the year-long program showed a significant improvement in mean self-efficacy scores for the total score and for each of the six domains in general knowledge, teaching, research, and advocacy in health policy. Compared to the baseline scores, after the program the total mean score increased from 3.1 to 4.1, an increase of 1.1 points on a 5-point Likert scale (95% CI: 0.9-1.3; Cohen's D: 1.7), with 61.4% of respondents increasing their mean score by at least 1 point. Responses to open-ended questions indicated that the program met scholars' stated needs to improve their knowledge base in health policy and advocacy skills. DISCUSSION The LEAHP program provides an opportunity for mentored, experiential training in health policy and advocacy, can build the knowledge and amplify the scale of physicians engaged in health policy, and help move physicians from individual patient advocacy in the clinic to that of populations.
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Affiliation(s)
- Kelly A Kyanko
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
| | - Molly A Fisher
- Academic Internal Medicine, Medicine Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Latonya Riddle-Jones
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Anders Chen
- Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Thomas Staiger
- Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Mark D Schwartz
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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23
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The Structural Analysis: Incorporating Structurally Competent Clinical Reasoning into Case-Based Presentations. J Gen Intern Med 2022; 37:3465-3470. [PMID: 35922707 PMCID: PMC9362667 DOI: 10.1007/s11606-022-07751-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/20/2022] [Indexed: 10/28/2022]
Abstract
Structural and social determinants of health account for the health disparities we see along social hierarchies, and their impact has been made more evident by the recent COVID-19 pandemic. There have been increasing calls to incorporate structural competency into medical education. The structural and social context, however, has yet to be fully integrated into everyday clinical practice and little has been published on how to concretely imbed structural competency into clinical reasoning. The authors provide a framework for structural analysis, which incorporates four key steps: (1) developing a prioritized clinical problem list, (2) identifying social and structural root causes for clinical problems, (3) constructing and documenting a prioritized structural problem list, and (4) brainstorming solutions to address structural barriers and social needs. They show how structural analysis can be used to operationalize structural reasoning into everyday inpatient and outpatient clinical assessments.
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24
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Vermette D, Doolittle B, Gielissen KA. Assessing Well-Being in Milestones 2.0: A Case for Flourishing-Focused Advising. J Grad Med Educ 2022; 14:390-393. [PMID: 35991094 PMCID: PMC9380626 DOI: 10.4300/jgme-d-21-00970.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- David Vermette
- All authors are with the Yale School of Medicine
- David Vermette, MD, MBA, is a Medical Education Fellow, Section of General Internal Medicine, and Clinical Fellow, Section of Pediatric Hospital Medicine
| | - Benjamin Doolittle
- All authors are with the Yale School of Medicine
- Benjamin Doolittle, MD, MDiv, is Professor of Internal Medicine and Pediatrics
| | - Katherine Ann Gielissen
- All authors are with the Yale School of Medicine
- Katherine Ann Gielissen, MD, MHS, is Assistant Professor of Internal Medicine and Pediatrics
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25
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Jindal M, Thornton RL, McRae A, Unaka N, Johnson TJ, Mistry KB. Effects of a Curriculum Addressing Racism on Pediatric Residents' Racial Biases and Empathy. J Grad Med Educ 2022; 14:407-413. [PMID: 35991090 PMCID: PMC9380619 DOI: 10.4300/jgme-d-21-01048.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/22/2022] [Accepted: 04/26/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Racism is a longstanding driver of health inequities. Although medical education is a potential solution to address racism in health care, best practices remain unknown. OBJECTIVE We sought to evaluate the impact of participation in a curriculum addressing racism on pediatric residents' racial biases and empathy. METHODS A pre-post survey study was conducted in 2 urban, university-based, midsized pediatric residency programs between July 2019 and June 2020. The curriculum sessions included Self-Reflection on Implicit Bias, Historical Trauma, and Structural Racism. All sessions were paired with empathy and perspective-taking exercises and were conducted in small groups to facilitate reflective discussion. Wilcoxon signed rank tests were used to assess changes in racial bias and empathy. Linear regression was used to assess the effect of resident characteristics on racial bias and empathy. RESULTS Ninety of 111 residents receiving the curriculum completed pre-surveys (81.1%), and among those, 65 completed post-surveys (72.2%). Among participants with baseline pro-White bias, there was a statistically significant shift (0.46 to 0.36, P=.02) toward no preference. Among participants with a baseline pro-Black bias, there was a statistically significant shift (-0.38 to -0.21, P=.02), toward no preference. Among participants with baseline pro-White explicit bias, there was a statistically significant shift (0.54 to 0.30, P<.001) toward no preference. Among all residents, there was a modest but statistically significant decrease in mean empathy (22.95 to 22.42, P=.03). CONCLUSIONS Participation in a longitudinal discussion-based curriculum addressing racism modestly reduced pediatric residents' racial preferences with minimal effects on empathy scales.
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Affiliation(s)
- Monique Jindal
- Monique Jindal, MD, MPH, is Assistant Professor, Department of Medicine, University of Illinois Chicago
| | - Rachel L.J. Thornton
- Rachel L.J. Thornton, MD, PhD, is Associate Professor, Department of Pediatrics, Johns Hopkins University School of Medicine, and Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Ashlyn McRae
- Ashlyn McRae, MD, is a Resident Physician, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Ndidi Unaka
- Ndidi Unaka, MD, MEd, is Associate Professor, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine
| | - Tiffani J. Johnson
- Tiffani J. Johnson, MD, MSc, is Assistant Professor, Department of Emergency Medicine, University of California, Davis
| | - Kamila B. Mistry
- Kamila B. Mistry, PhD, MPH, is Senior Advisor for Child Health and Quality Improvement, Office of Extramural Research, Education, and Priority Populations, Agency for Healthcare Research and Quality, US Department of Health and Human Services, and Assistant Professor, Department of Pediatrics, Johns Hopkins University School of Medicine
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Krohn KM, Crichlow R, McKinney ZJ, Tessier KM, Scheurer JM, Olson AP. Introducing Mass Communications Strategies to Medical Students: A Novel Short Session for Fourth-Year Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:999-1003. [PMID: 34879007 PMCID: PMC9170836 DOI: 10.1097/acm.0000000000004555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PROBLEM The World Health Organization calls on all with quality medical information to share it with the public and combat health misinformation; however, U.S. medical schools do not currently teach students effective communication with lay audiences about health. Most physicians have inadequate training in mass communication strategies. APPROACH In August 2018, a novel 90-minute class at the University of Minnesota Medical School introduced fourth-year medical students to basic skills for communicating with lay audiences through mass media. Instructors were physicians with experience interacting with the general public via radio, op-ed articles, social media, print media, television, and community and legislative advocacy. After a 20-minute lecture and sharing of instructors' personal experiences, students completed two 30-minute small-group activities. They identified communications objectives and talking points for a health topic, drafting these as Tweets or an op-ed article outline, then presented talking points in a mock press conference with their peers, practicing skills just learned. Pre- and postsurveys documented students' previous engagement and comfort with future engagement with mass media messaging. OUTCOMES Over 1 week, 142 students participated in 6 separate classes, and 127 completed both pre- and postsurveys. Before the course, only 6% (7/127) of students had comfortably engaged with social media and 14% (18/127) had engaged with traditional media in their professional roles. After the course, students self-reported an increase in their comfort, perceived ability, and likelihood of using specific communications skills to advocate for their patients (all P < .001). NEXT STEPS The course will be expanded into a 5-session thread for third- and fourth-year medical students spread over 2 years. This thread will include meeting physicians who engage with lay audiences, identifying best practices for mass health communication, identifying bias and misinformation, "dos and don'ts" of social media, and communication skills for legislative advocacy.
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Affiliation(s)
- Kristina M. Krohn
- K.M. Krohn is assistant professor and hospitalist, Department of Internal Medicine and Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0001-6116-7128
| | - Renee Crichlow
- R. Crichlow is chief medical officer, Codman Square Health Center, and vice-chair of health equity, Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-6284-1679
| | - Zeke J. McKinney
- Z.J. McKinney is an occupational medicine physician, HealthPartners Occupational and Environmental Medicine Residency, St. Paul, Minnesota, affiliate assistant professor, Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, and clinical investigator, HealthPartners Institute, Bloomington, Minnesota; ORCID: https://orcid.org/0000-0002-1858-8426
| | - Katelyn M. Tessier
- K.M. Tessier is a biostatistician, Masonic Cancer Center, Biostatistics Core, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0002-5513-583X
| | - Johannah M. Scheurer
- J.M. Scheurer is assistant professor and neonatologist, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0002-6554-4901
| | - Andrew P.J. Olson
- A.P.J. Olson is associate professor and head, Section of Hospital Medicine, Department of Internal Medicine and Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0002-7226-5783
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Joshi A, Heller RE, Acharya PT, Milla SS, Annam A. Pediatric radiology and advocacy: a professional responsibility. Pediatr Radiol 2022; 52:1412-1419. [PMID: 35438329 PMCID: PMC9016121 DOI: 10.1007/s00247-022-05369-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/04/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Aparna Joshi
- Section of Pediatric Radiology, C. S. Mott Children's Hospital, Department of Radiology, University of Michigan, Room 3-220, 1540 E. Hospital Drive, Ann Arbor, MI, 48109-4252, USA.
| | | | - Patricia T Acharya
- Department of Radiology, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Sarah S Milla
- Department of Radiology, Children's Hospital Colorado, Aurora, CO, USA
| | - Aparna Annam
- Department of Radiology, Children's Hospital Colorado, Aurora, CO, USA
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28
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Janeway M, Wilson S, Sanchez SE, Arora TK, Dechert T. Citizenship and Social Responsibility in Surgery: A Review. JAMA Surg 2022; 157:532-539. [PMID: 35385071 DOI: 10.1001/jamasurg.2022.0621] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Social determinants of health have been shown to be key drivers of disparities in access to surgical care and surgical outcomes. Though the concept of social responsibility has received growing attention in the medical field, little has been published contextualizing social responsibility in surgery. In this narrative review, we define social responsibility as it relates to surgery, explore the duty of surgeons to society, and provide examples of social factors associated with adverse surgical outcomes and how they can be mitigated. Observations The concept of social responsibility in surgery has deep roots in medical codes of ethics and evolved alongside changing views on human rights and the role of social factors in disease. The ethical duty of surgeons to society is based on the ethical principles of benevolence and justice and is grounded within the framework of the social contract. Surgeons have a responsibility to understand how factors such as patient demographics, the social environment, clinician awareness, and the health care system are associated with inequitable patient outcomes. Through education, we can empower surgeons to advocate for their patients, address the causes and consequences of surgical disparities, and incorporate social responsibility into their daily practice. Conclusions and Relevance One of the greatest challenges in the field of surgery is ensuring that surgical care is provided in an equitable and sustainable way. Surgeons have a duty to understand the factors that lead to health care disparities and use their knowledge, skills, and privileged position to address these issues at the individual and societal level.
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Affiliation(s)
- Megan Janeway
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Spencer Wilson
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Sabrina E Sanchez
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Tania K Arora
- Augusta University at the Medical College of Georgia, Augusta
| | - Tracey Dechert
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
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Louisias M, Hicks R, Jacobs S, Foggs MB. The Role of Physician Advocacy in Achieving Health Equity: Where Is the Allergist-Immunologist? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:910-917. [PMID: 35131512 PMCID: PMC9007906 DOI: 10.1016/j.jaip.2022.01.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/18/2022] [Accepted: 01/28/2022] [Indexed: 05/16/2023]
Abstract
As allergists and immunologists many of us have likely worked in the capacity of being an advocate for individual patients. However, how many of us are aware of our ability to be effective advocates who address root causes of health issues through policy changes? Physician advocacy is not a core competency medical specialty training (except pediatrics), yet physicians' clinical and research expertise and professional experience can be leveraged to shape policy. This rostrum describes the spectrum of activities for a physician advocate, barriers to physician advocacy, and actionable steps to encouraging the training and expansion of advocacy efforts by allergists and immunologists.
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Affiliation(s)
- Margee Louisias
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass; Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Roselyn Hicks
- Department of Pediatrics, Morehouse School of Medicine, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga
| | - Samantha Jacobs
- Department of Pediatrics, New York University School of Medicine, New York, NY
| | - Michael B Foggs
- Advocate Medical Group, Advocate Aurora Health, Chicago, Ill
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Huang YM, Chan HY, Lee PI, Tang YW, Chiou TW, Liu KCSC, Ho YF. Exploration of changes in pharmacy students' perceptions of and attitudes towards professionalism: outcome of a community pharmacy experiential learning programme in Taiwan. BMC MEDICAL EDUCATION 2022; 22:195. [PMID: 35313880 PMCID: PMC8938161 DOI: 10.1186/s12909-022-03261-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/14/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND A powerful way to nurture and strengthen professionalism is by accruing practice-based experiences. However, few studies in Taiwan have evaluated the impacts of experiential learning programmes on pharmacy students' views on professionalism - the core of quality healthcare practices and services. This study aimed to measure changes in perceptions of and attitudes towards professionalism among third-year pharmacy students following an introductory-intermediate experiential learning course. METHODS A single-group pre- and postcourse comparative study using a self-administered survey was conducted in 2017. Pharmacy students in their third year of a six-year programme were eligible to participate in this study. We used a 28-item questionnaire with a 10-point Likert-type scale to assess students' professionalism. Among them, 10 items were employed to assess students' perceived importance of professionalism in pharmacy practice, and another 18 items adapted from the Pharmacy Professionalism Instrument were used to evaluate students' attitudes towards pharmacy professionalism. An independent t test was performed to compare the differences in students' anonymous survey responses before and after the course, with an a priori level of statistical significance of 0.05. RESULTS Fifty-two pharmacy students participated in the study. They showed significant improvement in three tenets of professionalism, namely, altruism (p = 0.035), accountability (p = 0.026), and duty (p = 0.002), after completing the 5-week experiential course. CONCLUSIONS Pharmacy students' attitudes towards professionalism were modifiable by purposely designed experiential learning programme in the community setting. Such experiences may help socialize students with positive attitudes towards altruism, accountability, and duty.
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Affiliation(s)
- Yen-Ming Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, 100025, Taipei, Taiwan
| | - Hsun-Yu Chan
- Department of Industrial Education, National Taiwan Normal University, 106308, Taipei, Taiwan
| | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, 100226, Taipei, Taiwan
| | - Yun-Wen Tang
- Department of Pharmacy, National Taiwan University Hospital, College of Medicine, National Taiwan University, 100225, Taipei, Taiwan
| | - Ta-Wei Chiou
- School of Pharmacy, College of Medicine, National Taiwan University, 100025, Taipei, Taiwan
| | - Karin C S Chen Liu
- School of Pharmacy, College of Medicine, National Taiwan University, 100025, Taipei, Taiwan
| | - Yunn-Fang Ho
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, 100025, Taipei, Taiwan.
- School of Pharmacy, College of Medicine, National Taiwan University, 100025, Taipei, Taiwan.
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Jindal M, Mistry KB, McRae A, Unaka N, Johnson T, Thornton RLJ. "It Makes Me a Better Person and Doctor": A Qualitative Study of Residents' Perceptions of a Curriculum Addressing Racism. Acad Pediatr 2022; 22:332-341. [PMID: 34923147 DOI: 10.1016/j.acap.2021.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Explore how pediatric residents perceive the impact of a curriculum addressing racism on their knowledge, motivation, skills and behaviors, and investigate the contextual factors that promote or impede the curriculum's effectiveness. METHODS Open-ended, semistructured interviews were conducted at 2 academic medical centers between August 2019 and 2020 among pediatric residents who participated in the curriculum. Interviews were recorded, transcribed, and analyzed by using inductive content analysis. RESULTS Pediatric residents (n = 16) were predominantly white (66.7%), female (86.7%) interns (60%) from the Midwest (40%). Six major themes emerged describing the perceived impact of the curriculum on: knowledge - (1) Understanding of race and racism as structural forces in a historical context; motivation - (2) Owning the issue of racism, (3) Having the curriculum makes a statement; skills - (4) Critical self-reflection, (5) Perceived development of skills to mitigate biases; and action-planning - (6) Turning insight into strategies to combat racism and improve patient care. Two additional themes emerged describing contextual factors that promoted or impeded the curriculum such as the content of the curriculum itself, the racial demographics of the participants, the implementation infrastructure and environmental factors such as the culture of the training program. CONCLUSIONS Medical education addressing racism can facilitate the perceived acquisition of foundational knowledge regarding race and racism; motivation and skill-building to combat racism; and action planning aimed at improving patient care. Contextual factors should be considered when developing and implementing such curricula to not only promote racial equity but avoid unintended harms.
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Affiliation(s)
- Monique Jindal
- Division of General Pediatrics, Department of Pediatrics (M Jindal, KB Mistry, RLJ Thornton), Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Kamila B Mistry
- Division of General Pediatrics, Department of Pediatrics (M Jindal, KB Mistry, RLJ Thornton), Johns Hopkins University School of Medicine, Baltimore, Md; Office of Extramural Research, Education, and Priority Populations (KB Mistry), Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Md
| | - Ashlyn McRae
- Division of General Pediatrics, Department of Pediatrics (M Jindal, KB Mistry, RLJ Thornton), Johns Hopkins University School of Medicine, Baltimore, Md
| | - Ndidi Unaka
- Division of Hospital Medicine (N Unaka), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (N Unaka), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tiffani Johnson
- Department of Emergency Medicine (T Johnson), University of California, Davis, Calif
| | - Rachel L J Thornton
- Division of General Pediatrics, Department of Pediatrics (M Jindal, KB Mistry, RLJ Thornton), Johns Hopkins University School of Medicine, Baltimore, Md; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society (RLJ Thornton), Baltimore, Md
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Emery EH, Shaffer JD, McCormick D, Zeidman J, Geffen SR, Stojicic P, Ganz M, Basu G. Preparing Doctors in Training for Health Activist Roles: A Cross-Institutional Community Organizing Workshop for Incoming Medical Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11208. [PMID: 35106380 PMCID: PMC8763867 DOI: 10.15766/mep_2374-8265.11208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/22/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Physicians are increasingly being called on to address inequities created by social and structural determinants of health, yet few receive training in specific leadership skills that allow them to do so effectively. METHODS We developed a workshop to introduce incoming medical interns from all specialties at Boston-area residency programs to community organizing as a framework for effective physician advocacy. We utilized didactic sessions, video examples, and small-group practice led by trained coaches to familiarize participants with one community organizing leadership skill-public narrative-as a means of creating the relationships that underlie collective action. We offered this 3-hour, cross-institutional workshop just prior to intern orientation and evaluated it through a postworkshop survey. RESULTS In June 2019, 51 residents from 13 programs at seven academic medical centers attended this workshop. In the postworkshop survey, participants agreed with positive evaluative statements about the workshop's value and impact on their knowledge, with a mean score on all items of over 4 (5-point Likert scale, 1 = strongly disagree, 5 = strongly agree; response rate: 34 of 51). Free-text comments emphasized the workshop's effectiveness in evoking positive feelings of solidarity, community, and professional identity. DISCUSSION The workshop effectively introduced participants to community organizing and public narrative, allowed them to apply the principles of public narrative by developing their own stories of self, and demonstrated how these practices can be utilized in physician advocacy. The workshop also connected participants to their motivations for pursuing medicine and stimulated interest in more community organizing training.
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Affiliation(s)
- Eleanor H. Emery
- Program Officer, Center for Health Equity Education and Advocacy, Cambridge Health Alliance; Instructor of Medicine, Part-time, Harvard Medical School; Medical Officer-Physician, Department of Internal Medicine, Northern Navajo Medical Center
| | | | - Danny McCormick
- Co-Director, Center for Health Equity Education and Advocacy, Cambridge Health Alliance; Associate Professor of Medicine, Harvard Medical School
| | - Jessica Zeidman
- Primary Care Program Director, Department of Internal Medicine, Massachusetts General Hospital; Instructor of Medicine, Harvard Medical School
| | - Sophia R. Geffen
- Program Manager, Center for Health Equity Education and Advocacy, Cambridge Health Alliance
| | - Predrag Stojicic
- Instructor, Harvard T.H. Chan School of Public Health; Program Director for Community Organizing, Center for Health Equity Education and Advocacy, Cambridge Health Alliance; Executive Director, People Power Health
| | - Marshall Ganz
- Rita E. Hauser Senior Lecturer in Leadership, Organizing, and Civil Society, Harvard Kennedy School
| | - Gaurab Basu
- Co-Director, Center for Health Equity Education and Advocacy, Cambridge Health Alliance; Instructor of Medicine, Harvard Medical School
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Wang X, Qin H, Zhu Y, Wang Z, Ye B, Zhu X, Liang Y. Association of off-the-job training with work performance and work-family conflict among physicians: a cross-sectional study in China. BMJ Open 2022; 12:e053280. [PMID: 35017246 PMCID: PMC8753420 DOI: 10.1136/bmjopen-2021-053280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To determine whether experiences of off-the-job training in domestic (DT) and overseas study (OS) settings are associated with work performance and work-family conflict in physicians. DESIGN, SETTING AND PARTICIPANTS We conducted a national cross-sectional survey in 77 public hospitals across seven provinces in China between July 2014 and April 2015. Participants were 3182 physicians. EXPOSURE Participants were categorised into four groups: none, DT only, OS only and DT and OS. PRIMARY OUTCOME MEASURES Work performance was assessed by work engagement, career attrition and patient-centred care. Work-family conflict was assessed by affecting care for family, feeling guilty towards family and receiving complaints from family. RESULTS A total of 25.89% participants had experienced DT only, 8.71% OS only and 8.47% DT and OS. After adjustment for potential confounders, participants who had experiences of DT and OS compared with those with no training were more likely to report positive work performance (pride in work: OR=2.11, 95% CI: 1.43 to 3.10; enjoyment of work: OR=1.67, 95% CI: 1.11 to 2.51; turnover intention: OR=0.54, 95% CI: 0.38 to 0.77; early retirement: OR=0.63, 95% CI: 0.45 to 0.89; and exhaustion: OR=0.66, 95% CI: 0.45 to 0.98) and less work-family conflicts (feeling guilty towards family: OR=0.51, 95% CI: 0.35 to 0.74; and complaints from family: OR=0.66, 95% CI: 0.47 to 0.91). We found no obvious association between DT/OS experience with patient-centred care. CONCLUSIONS Physicians with DT and OS experiences are more likely to have better work performance and less work-family conflict than those without such experience. Physicians face increasing pressure to pursue continuing education and experience associated distress. Therefore, hospitals and government policy-makers should promote DT and OS.
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Affiliation(s)
- Xiaoyu Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hua Qin
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yimei Zhu
- Department of Media and Communication, University of Leicester, Leicester, UK
| | - Zixin Wang
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Beizhu Ye
- Department of Social Medicine and Health Management, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xi Zhu
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Yuan Liang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Smith T. From Courtroom to Clinic: Child Advocacy in Action. MISSOURI MEDICINE 2022; 119:533-535. [PMID: 36588642 PMCID: PMC9762227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Kuehne F, Kalkman L, Joshi S, Tun W, Azeem N, Buowari DY, Amugo C, Kallestrup P, Kraef C. Healthcare Provider Advocacy for Primary Health Care Strengthening: A Call for Action. J Prim Care Community Health 2022; 13:21501319221078379. [PMID: 35289207 PMCID: PMC8928351 DOI: 10.1177/21501319221078379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022] Open
Abstract
Primary Health Care (PHC) is the backbone of health systems and a cornerstone of Universal Health Coverage. In 2018, political commitment to PHC, including a comprehensive approach based on essential care throughout the lifespan, integrated public health functions, and community empowerment was reaffirmed by international stakeholders in Astana. As recent events exposed weaknesses of health care systems worldwide, growing attention has been paid to strengthening PHC. While the role of care providers as health advocates has been recognized, they may lack skills, opportunities, and resources to actively engage in advocacy. Particularly for PHC providers, guidance and tools on how to advocate to strengthen PHC are scarce. In this article, we review priority policy areas for PHC strengthening with relevance for several settings and health care systems and propose approaches to empower PHC providers-physician, non-physician, or informal PHC providers-to advocate for strengthening PHC in their countries by individual or collective action. We provide initial ideas for a stepwise advocacy strategy and recommendations for practical advocacy activities. Our aim is to initiate further discussion on how to strengthen health care provider driven advocacy for PHC and to encourage advocates in the field to reflect on their opportunities for local, national, and global action.
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Affiliation(s)
- Flora Kuehne
- LMU University Hospital, Institute for General Practice and Family Medicine, Munich, Germany
| | - Laura Kalkman
- Medische Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Shiv Joshi
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
| | - Wunna Tun
- Independent Researcher, Yangon, Myanmar
| | | | | | - Chioma Amugo
- Ashford and Saint Peter’s Hospitals NHS Trust, Chertsey, UK
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Brender TD, Plinke W, Arora VM, Zhu JM. Prevalence and Characteristics of Advocacy Curricula in U.S. Medical Schools. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1586-1591. [PMID: 34039856 DOI: 10.1097/acm.0000000000004173] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Recent national events, including the COVID-19 pandemic and protests of racial inequities, have drawn attention to the role of physicians in advocating for improvements in the social, economic, and political factors that affect health. Characterizing the current state of advocacy training in U.S. medical schools may help set expectations for physician advocacy and predict future curricular needs. METHOD Using the member school directory provided by the Association of American Medical Colleges, the authors compiled a list of 154 MD-granting medical schools in the United States in 2019-2020. They used multiple search strategies to identify online course catalogues and advocacy-related curricula using variations of the terms "advocacy," "policy," "equity," and "social determinants of health." They used an iterative process to generate a preliminary coding schema and to code all course descriptions, conducting content analysis to describe the structure of courses and topics covered. RESULTS Of 134 medical schools with any online course catalogue available, 103 (76.9%) offered at least 1 advocacy course. Required courses were typically survey courses focused on general content in health policy, population health, or public health/epidemiology, whereas elective courses were more likely to focus specifically on advocacy skills building and to feature field experiences. Of 352 advocacy-specific courses, 93 (26.4%) concentrated on a specific population (e.g., children or persons with low socioeconomic status). Few courses (n = 8) focused on racial/ethnic minorities and racial inequities. CONCLUSIONS Findings suggest that while most U.S. medical schools offer at least 1 advocacy course, the majority are elective rather than required, and the structure and content of advocacy-related courses vary substantially. Given the urgency to address social, economic, and political factors affecting health and health equity, this study provides an important and timely overview of the prevalence and content of advocacy curricula at U.S. medical schools.
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Affiliation(s)
- Teva D Brender
- T.D. Brender is a medical student, Oregon Health & Science University, Portland, Oregon
| | - Wesley Plinke
- W. Plinke is a medical student, Oregon Health & Science University, Portland, Oregon
| | - Vineet M Arora
- V.M. Arora is the Herbert T. Abelson Professor of Medicine and assistant dean, Scholarship and Discovery, University of Chicago School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-4745-7599
| | - Jane M Zhu
- J.M. Zhu is assistant professor of medicine, Division of General Internal Medicine, Oregon Health & Science University, Portland, Oregon; ORCID: http://orcid.org/0000-0002-4868-6078
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Shah RM, Shope ET. Using orientation to create community connections and resident advocates. J Dent Educ 2021; 86 Suppl 1:874-877. [PMID: 34561877 DOI: 10.1002/jdd.12797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/08/2021] [Accepted: 08/11/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Ritu M Shah
- Division of Pediatric Dentistry, University of Rochester/Eastman Institute for Oral Health, Rochester, New York, USA
| | - Erin T Shope
- Division of Pediatric Dentistry, University of Rochester/Eastman Institute for Oral Health, Rochester, New York, USA
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Winthrop ZA, Michelson CD, Nash KA. Training the Next Generation of Pediatrician-Advocates: A New Focus on the Inpatient Setting. Hosp Pediatr 2021; 11:e266-e269. [PMID: 34493588 DOI: 10.1542/hpeds.2021-005983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Zachary A Winthrop
- The Boston Combined Residency Program, Boston Children's Hospital and Boston Medical Center, Boston, Massachusetts
| | - Catherine D Michelson
- Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts.,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Katherine A Nash
- National Clinician Scholars Program.,Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
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Changing Obstetrics and Gynecology Residency Education to Combat Reproductive Injustice: A Call to Action. Obstet Gynecol 2021; 137:717-722. [PMID: 33706356 DOI: 10.1097/aog.0000000000004297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/17/2020] [Indexed: 10/21/2022]
Abstract
Although reproductive injustices and reproductive health disparities are well-documented in the United States, recent studies have begun to explore the health care professional's role in their perpetuation. We hypothesized that obstetrics and gynecology residents would observe reproductive injustices during their training. Thus, using a national survey, we asked obstetrics and gynecology residents to share clinical cases in which discrimination, bias, inequity, or injustice was involved in a patient's reproductive health care and queried their preparedness to respond. Through qualitative analysis, we found that respondents shared cases involving racism, discrimination, and structural barriers to care and that they felt poorly equipped to handle injustice. We call for clinician educators to combat reproductive injustice through three key changes to obstetrics and gynecology residency training: 1) incorporate reproductive justice training into formal residency education; 2) create safe spaces for residents to collectively debrief about their experiences with injustice and collaborate on care improvement; and 3) teach community engagement and advocacy skills that identify, center, and elevate local reproductive health priorities.
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Lessons from Asylum Seekers: How Forensic Medical Evaluations Can Teach Us Things We Didn't Learn in Medical School. J Gen Intern Med 2021; 36:2121-2122. [PMID: 32875493 PMCID: PMC8298660 DOI: 10.1007/s11606-020-06157-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
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Petriceks AH, Kumar A, Schwartz AW. The urgency of now: Opportunities for advocacy among geriatrics health professionals and trainees. J Am Geriatr Soc 2021; 69:2445-2448. [PMID: 34048601 DOI: 10.1111/jgs.17300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/26/2021] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Andrea Wershof Schwartz
- Harvard Medical School, Boston, Massachusetts, USA.,New England Geriatric Research, Education, and Clinical Center and Division of Geriatrics and Palliative Care, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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LaDonna KA, Watling CJ, Cristancho SM, Burm S. Exploring patients' and physicians' perspectives about competent health advocacy. MEDICAL EDUCATION 2021; 55:486-495. [PMID: 33152148 DOI: 10.1111/medu.14408] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Many residency programmes struggle to demonstrate how they prepare trainees to become competent health advocates. To meaningfully teach and assess it, we first need to understand what 'competent' health advocacy (HA) is and what competently enacting it requires. Attempts at clarifying HA have largely centred around the perspectives of consultant physicians and trainees. Without patients' perspectives, we risk training learners to advocate in ways that may be misaligned with patients' needs and goals. Therefore, the purpose of our research was to generate a multi-perspective understanding about the meaning of competence for the HA role. METHODS We used constructivist grounded theory to explore patients' and physicians' perspectives about competent health advocacy. Data were collected using photo elicitation; patients (n = 10) and physicians (n = 14) took photographs depicting health advocacy that were used to inform semi-structured interviews. Themes were identified using constant comparative analysis. RESULTS Physician participants associated HA with disruption or political activism, suggesting that competence hinged on medical and systems expertise, a conducive learning environment, and personal and professional characteristics including experience, status and political savvy. Patient participants, however, equated physician advocacy with patient centredness, perceiving that competent HAs are empathetic and attentive listeners. In contrast to patients, few physicians identified as advocates, raising questions about their ability to train or to thoughtfully assess learners' abilities. CONCLUSION Few participants perceived HA as a fundamental physician role-at least not as it is currently defined in curricular frameworks. Misperceptions that HA is primarily disruptive may be the root cause of the HA problem; solving it may rely on focusing training on bolstering skills like empathy and listening not typically associated with the HA role. Since there may be no competency where the patient voice is more critical, we need to explore opportunities for patients to facilitate learning for the HA role.
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Affiliation(s)
- Kori A LaDonna
- Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Christopher J Watling
- Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sayra M Cristancho
- Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sarah Burm
- Division of Medical Education, Dalhousie University, Halifax, NS, Canada
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Chawla KS, Jayaram A, McClain CD. The Missing Chapter: The Education of Surgery and Anesthesiology Trainees as Civic Advocates. Ann Surg 2021; 273:e125-e126. [PMID: 33351468 DOI: 10.1097/sla.0000000000004723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The SARS-CoV-2 pandemic has highlighted existing systemic inequities that adversely affect a variety of communities in the United States. These inequities have a direct and adverse impact on the healthcare of our patient population. While civic engagement has not been cultivated in surgical and anesthesia training, we maintain that it is inherent to the core role of the role of a physician. This is supported by moral imperative, professional responsibility, and a legal obligation. We propose that such civic engagement and social justice activism is a neglected, but necessary aspect of physician training. We propose the implementation of a civic advocacy education agenda across department, community and national platforms. Surgical and anesthesiology residency training needs to evolve to the meet these increasing demands.
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Affiliation(s)
- Kashmira S Chawla
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Anusha Jayaram
- Tufts University School of Medicine, Boston, Massachusetts
- Global Surgery Student Alliance (GSSA), Cambridge, Massachusetts
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Craig D McClain
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
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Sieplinga K, Disbrow E, Triemstra J, van de Ridder M. Off to a Jump Start: Using Immersive Activities to Integrate Continuity Clinic and Advocacy. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:23821205211059652. [PMID: 34926827 PMCID: PMC8671658 DOI: 10.1177/23821205211059652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/14/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Training in advocacy is an important component of graduate medical education. Several models have been implemented by residency programs to address this objective. Little has been published regarding application of immersive advocacy activities integrated into continuity clinic. OBJECTIVE To create an Integrated Community Health and Child Advocacy Curriculum (ICHCA) by integrating advocacy activities that were immersive and contextualized in a continuity clinic setting and to familiarize interns with continuity clinic immediately at the beginning of their training. METHODS We utilized a socio-constructivist lens, Kern's Six-step curriculum development and a published curriculum mapping tool to create the curriculum. Twenty residents completed ICHCA in 2019. Evaluations from key stakeholders including participants, support staff and attendings were analyzed on four levels of Kirkpatrick's model. We compared results before intervention, immediately following intervention and ten months following intervention. RESULTS We demonstrated improvement in learner satisfaction, knowledge and behaviors with respect to advocacy in the clinical environment. Response rate was 70% (7/10) for attendings, 75% for support staff (15/20) and 72.5% for residents (29/40). Our intervention was feasible, no cost, and required no additional materials or training as it relied on learning in real time. CONCLUSIONS An integrated advocacy curriculum utilizing the mapping tool for curricular design and evaluation is feasible and has value demonstrated by improvements in reaction, knowledge, and behaviors. This model improves understanding of social responsibility and can be implemented similarly in other residency programs.
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Affiliation(s)
- Kira Sieplinga
- Michigan State University College of Human Medicine, Pediatric Residency Spectrum Health/Helen DeVos Children’s Hospital, Grand Rapids, MI, USA
| | - Emily Disbrow
- Michigan State University College of Human Medicine, Pediatric Residency Sparrow Hospital, Lansing, MI, USA
| | - Justin Triemstra
- Michigan State University College of Human Medicine, Pediatric Residency Spectrum Health/Helen DeVos Children’s Hospital, Grand Rapids, MI, USA
| | - Monica van de Ridder
- Michigan State University College of Human Medicine, Pediatric Residency Spectrum Health/Helen DeVos Children’s Hospital, Grand Rapids, MI, USA
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Unger JP, Morales I, De Paepe P, Roland M. Integrating clinical and public health knowledge in support of joint medical practice. BMC Health Serv Res 2020; 20:1073. [PMID: 33292211 PMCID: PMC7724788 DOI: 10.1186/s12913-020-05886-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Strong relations between medicine and public health have long been advocated. Today, professional medical practice assumes joint clinical/public health objectives: GPs are expected to practice community medicine; Hospital specialists can be involved in disease control and health service organisation; Doctors can teach, coach, evaluate, and coordinate care; Clinicians should interpret protocols with reference to clinical epidemiology. Public health physicians should tailor preventive medicine to individual health risks. This paper is targeted at those practitioners and academics responsible for their teams' professionalism and the accessibility of care, where the authors argue in favour of the epistemological integration of clinical medicine and public health. MAIN TEXT Based on empirical evidence the authors revisit the epistemological border of clinical and public health knowledge to support joint practice. From action-research and cognitive psychology, we derive clinical/public health knowledge categories that require different transmission and discovery techniques. The knowledge needed to support the universal human right to access professional care bridges both clinical and public health concepts, and summons professional ethics to validate medical decisions. To provide a rational framework for teaching and research, we propose the following categories: 'Know-how/practice techniques', corresponding a.o. to behavioural, communication, and manual skills; 'Procedural knowledge' to choose and apply procedures that meet explicit quality criteria; 'Practical knowledge' to design new procedures and inform the design of established procedures in new contexts; and Theoretical knowledge teaches the reasoning and theory of knowledge and the laws of existence and functioning of reality to validate clinical and public health procedures. Even though medical interventions benefit from science, they are, in essence, professional: science cannot standardise eco-biopsychosocial decisions; doctor-patient negotiations; emotional intelligence; manual and behavioural skills; and resolution of ethical conflicts. CONCLUSION Because the quality of care utilises the professionals' skill-base but is also affected by their intangible motivations, health systems should individually tailor continuing medical education and treat collective knowledge management as a priority. Teamwork and coaching by those with more experience provide such opportunities. In the future, physicians and health professionals could jointly develop clinical/public health integrated knowledge. To this end, governments should make provision to finance non-clinical activities.
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Affiliation(s)
- Jean-Pierre Unger
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium
| | - Ingrid Morales
- Office de la Naissance et de l’Enfance, French Community of Belgium, Chaussée de Charleroi 95, B-1060 Brussels, Belgium
| | - Pierre De Paepe
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium
| | - Michel Roland
- Département de Médecine Générale, Université Libre de Bruxelles, Route de Lennik, 808, BP 612/1, B-1070 Brussels, Belgium
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Teran PR, Wong R, Van Ramshorst RD, Loh M, Cherian S, Ahlers-Schmidt CR, Okut H, Kelly N. Evaluation of Legislative Advocacy Alerts for Pediatric Residents. Clin Pediatr (Phila) 2020; 59:500-504. [PMID: 32037863 DOI: 10.1177/0009922820904596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Rudolph Wong
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Miranda Loh
- University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Sheeba Cherian
- University of Texas at Austin Dell Medical School, Austin, TX, USA
| | | | - Hayrettin Okut
- University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Nancy Kelly
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Affiliation(s)
- Jonathan E Fried
- Harvard Medical School, Boston, MA, USA.,John F. Kennedy School of Government at Harvard University, Cambridge, MA, USA
| | - Scott A Shipman
- Association of American Medical Colleges, Washington, DC, USA.,The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
| | - Laura L Sessums
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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The Vital Role of Professionalism in Physical Medicine and Rehabilitation. Am J Phys Med Rehabil 2019; 99:273-277. [DOI: 10.1097/phm.0000000000001322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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