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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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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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Warwick S, Kantor L, Ahart E, Twist K, Mabry T, Stoltzfus K. Physician Advocacy: Identifying Motivations for Work Beyond Clinical Practice. Kans J Med 2022; 15:433-436. [PMID: 36578458 PMCID: PMC9778720 DOI: 10.17161/kjm.vol15.18255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Advocacy is a perceived social and professional obligation of physicians. However, many feel their training and practice environment do not support increased engagement in advocacy. The aim of this qualitative project was to delineate the role that advocacy plays in physicians' careers and the factors driving physician engagement in advocacy. Methods Physicians engaged in health advocacy in Kansas were identified by personal contacts and referrals through snowball sampling. They received a standardized email invitation to participate in a short interview. These interviews were recorded and transcribed using Apple Voice Memos and Google Dictation. Two team members independently identified themes from interview transcripts, while a third member served as a moderator if themes identified were dyssynchronous. Results Of the 19 physicians invited to participate, 13 were interviewed. The most common reasons for engaging in advocacy included the desire to change policy, obligation to go beyond regular clinic duties, giving patients a voice, and avoiding burnout. Physicians reported passion for patients and past experiences with disparities as the most common inspiration. Most physicians did not receive formal advocacy training, but identified professional societies and peers as informal guides. Common supports for advocacy were professional organizations, community partners, and employers. Time was the most common barrier to conducting advocacy work. Conclusions Physicians have a broad number of reasons for the importance of doing advocacy work, but identify key professional barriers to further engagement. Providing accessible opportunities through professional organizations and community partnerships may increase advocacy participation.
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Affiliation(s)
- Sophia Warwick
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Laura Kantor
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS
| | - Erin Ahart
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS
| | - Katie Twist
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Terrance Mabry
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO
| | - Ky Stoltzfus
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
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Abrams EM, Louisias M, Blumenthal KG. The Importance of Physician Advocacy. Ann Allergy Asthma Immunol 2022; 129:679-680. [PMID: 35987456 DOI: 10.1016/j.anai.2022.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia.
| | - Margee Louisias
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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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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Spheres of Influence and Strategic Advocacy for Equity in Medicine. J Gen Intern Med 2021; 36:3537-3540. [PMID: 34013471 PMCID: PMC8133515 DOI: 10.1007/s11606-021-06893-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/03/2021] [Indexed: 11/03/2022]
Abstract
As the extent of health disparities in the USA has been revealed, particularly during the COVID-19 pandemic, physicians have increasingly attended to their roles as advocates for their patients and communities. This article presents "spheres of influence" as a concept that can help physicians think strategically about how to build upon their clinical work and expertise to promote equity in medicine. The physician's primary sphere of influence is in direct patient care. However, physicians today often have many other roles, especially within larger health care institutions in which physicians often occupy positions of authority. Physicians are therefore well-positioned to act within these spheres in ways that draw upon the ethical principles that guide patient care and contribute materially to the cause of equity for colleagues and patients alike. By making changes to the ways they already work within their clinical spaces, institutional leadership roles, and wider communities, physicians can counteract the structural problems that undermine the health of the patients they serve.
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Wald HS, Ruddy M. Surreal Becomes Real: Ethical Dilemmas Related to the COVID-19 Pandemic and Professional Identity Formation of Health Professionals. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2021; 41:124-129. [PMID: 33851809 DOI: 10.1097/ceh.0000000000000346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Fundamental quandaries of clinical and biomedical ethics for health care professionals, committees, and systems have been raised into stark relief by the COVID-19 pandemic. The nature and extent of critical issues raised by this ongoing crisis, including challenging ethical dilemmas for the health care profession, is likely to have an indelible impact on the professional identity formation (PIF) of learners and practitioners across the trajectory of the professional lifecycle. The lifelong process of PIF for health care practitioners, from learner through independent practice, is supported in medical education by intentional reflection, relationships within community of practice include guidance from mentoring, as well as resilience, both emotional and moral. We consider how grappling with ethical dilemmas related to the COVID-19 pandemic can challenge, inform, and even potentially transform the PIF process, thereby supporting development of a morally resilient, humanistic professional identity in health care trainees and health care professionals.
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Affiliation(s)
- Hedy S Wald
- Dr. Wald: Clinical Professor of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI; and
- Dr. Ruddy: Vice President for Academic Affairs, the Wright Center for Graduate Medical Education, Minneapolis, MN
| | - Meaghan Ruddy
- Dr. Wald: Clinical Professor of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI; and
- Dr. Ruddy: Vice President for Academic Affairs, the Wright Center for Graduate Medical Education, Minneapolis, MN
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Giri M, Palma M, Behrens D, Castro-Caballero Y, Fricchione M, Galeano X, Herring T, Elsner M. An American Academy of Pediatrics State Chapter Initiative Advocating for Immigrant Children and Families. Pediatr Ann 2020; 49:e228-e232. [PMID: 32413151 DOI: 10.3928/19382359-20200422-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Illinois Chapter, American Academy of Pediatrics Refugee Immigrant Child Health Initiative (RICHI), a collaboration of physicians and child advocates, is one of the most robust state chapter programs of its kind. RICHI evolved by tapping into its key demographics to discern both patient needs and providers' skill sets. Although both may be unique to Illinois and its provider base, they can nonetheless provide a framework for creating and guiding state chapters to support the special needs of children in immigrant families. This article illustrates the importance of identifying and analyzing relevant local demographic and policy-related concerns and how to build capacity, connect to local resources, and form key partnerships. [Pediatr Ann. 2020;49(5):e228-e232.].
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