First year medical student attitudes about advocacy in medicine across multiple fields of discipline: analysis of reflective essays

An Op-Ed Writing Curriculum for Medical Students to Engage in Advocacy Through Public Writing

BACKGROUND

Op-ed writing can be a powerful and accessible advocacy tool for physicians, but training is lacking in undergraduate medical education.

AIM

To train and engage first-year medical students in op-ed writing.

SETTING

Midwestern research-intensive medical school.

PARTICIPANTS

All students in a required first-year health policy course in 2021 and 2022.

PROGRAM DESCRIPTION

For their health policy course's final assignment, students could opt to write an op-ed on a healthcare issue of their choice. All students received written instruction on op-ed writing. Additionally, they could access a seminar, coaching and editing by peers and faculty, and publication guidance.

PROGRAM EVALUATION

Of 179 students over 2 years, 105 chose to write op-eds. Fifty-one attended the seminar, 35 attended peer coaching sessions, 33 accessed structured peer editing, and 23 received faculty assistance. Thirty-eight students submitted a total of 42 op-eds for publication. Twenty-two pieces were published in major outlets and 17 in the university's health policy review. Of the 22 in major outlets, 21 received editing from either peers or faculty.

DISCUSSION

An op-ed writing curriculum can be integrated into an existing medical school health policy course, resulting in a high level of engagement and in published op-eds by medical students.

The Efficacy of Short, Skills-based Workshops in Teaching Advocacy to Medical Students: A Pilot Study

Background and Objectives

This study evaluated the effectiveness of a short, skills-based workshop, called a Letter-Writing Lunch (LWL), in teaching advocacy to medical students.

Methods

We assessed political activity, political efficacy, civic responsibility, and skill mastery via pre-, post-, and 6-month follow-up surveys. Via semistructured follow-up interviews, we explored how the intervention affected the participant's view of advocacy.

Results

Students mastered identifying and contacting their representatives. Participants' political activity scores demonstrated little to no political activity at baseline and were unchanged at 6 months. Political efficacy scores increased after the event (t[53]=8.5, P<.001), and they remained elevated at 6 months (t[25]=2.1, P=.047). Feelings of civic responsibility significantly increased from the pre-to postsurvey (z=482.5, P<.001), but returned to baseline by 6 months. Four themes emerged from the follow-up interviews: (a) A disconnect exists between what medical students believe their responsibilities are and what they are doing; (b) medical students believe their current advocacy curriculum lacks depth and applicability; (c) students want programming that is realistic in the context of their limited time, varying passions, and current skill level; and (d) the LWL changed students' views on advocacy.

Conclusions

Current skills-based education is time-intensive and fails to engage students who are not already committed to developing advocacy skills. Keeping the LWL short in length successfully targeted students with little previous advocacy experience. The event increased political efficacy and civic responsibility while making advocacy appear more accessible. The LWL is an effective and efficient way to teach advocacy to medical students.

Flattening Hierarchical Structures to Empower Women Trainee Leaders on Social Media Teams

We share our experience empowering women trainees and leadership through a flattened hierarchical social media team structure with supporting evidence from measurable outcomes.

Preparing Medical Students to Address Health Disparities Through Longitudinally Integrated Social Justice Curricula: A Systematic Review

PURPOSE

The education of health care professionals is a contributing factor to persistent health disparities. Although medical students are expected to understand racism, classism, and other social and structural drivers of health (SDH), standardization and best practices for teaching these concepts are lacking. Some medical schools are adopting social justice curricula (SJC) that prioritize health equity in teaching students to recognize SDH and preparing them to address the consequent health disparities. This systematic review sought to evaluate how these schools have integrated SJC into their core teaching; the criteria they have used to measure success and to what extent these criteria are met; and best practices in planning, implementing, and evaluating SJC.

METHOD

The authors searched 7 databases for English-language studies published between January 2000 and April 2020, reporting on longitudinally integrated SJC at U.S. medical schools intended for all students. Quantitative and qualitative outcomes were synthesized and summarized.

RESULTS

Searches identified 3,137 articles, of which 11 met inclusion criteria. Results demonstrated schools use a variety of teaching methods over a wide range of didactic hours to teach SJC concepts. Surveys and objective tests indicated students in SJC are generally satisfied and demonstrated improved knowledge and skills related to understanding and mitigating SDH, although findings related to changes in attitudes were equivocal. Evaluations at graduation and in residency demonstrated students who experience SJC are more prepared than their peers to work with patients who are underserved. Best practices in SJC included addressing the hidden curriculum, considering medical mistrust, and using tools like the Racial Justice Report Card and Tool for Assessing Cultural Competence Training.

CONCLUSIONS

These findings indicated SJC can prepare students to better address the root causes of health disparities. Future research should consider the long-term influences of these curricula on students, patients, and the community.

New Horizons-Addressing Healthcare Disparities in Endocrine Disease: Bias, Science, and Patient Care

Unacceptable healthcare disparities in endocrine disease have persisted for decades, and 2021 presents a difficult evolving environment. The COVID-19 pandemic has highlighted the gross structural inequities that drive health disparities, and antiracism demonstrations remind us that the struggle for human rights continues. Increased public awareness and discussion of disparities present an urgent opportunity to advance health equity. However, it is more complicated to change the behavior of individuals and reform systems because societies are polarized into different factions that increasingly believe, accept, and live different realities. To reduce health disparities, clinicians must (1) truly commit to advancing health equity and intentionally act to reduce health disparities; (2) create a culture of equity by looking inwards for personal bias and outwards for the systemic biases built into their everyday work processes; (3) implement practical individual, organizational, and community interventions that address the root causes of the disparities; and (4) consider their roles in addressing social determinants of health and influencing healthcare payment policy to advance health equity. To care for diverse populations in 2021, clinicians must have self-insight and true understanding of heterogeneous patients, knowledge of evidence-based interventions, ability to adapt messaging and approaches, and facility with systems change and advocacy. Advancing health equity requires both science and art; evidence-based roadmaps and stories that guide the journey to better outcomes, judgment that informs how to change the behavior of patients, providers, communities, organizations, and policymakers, and passion and a moral mission to serve humanity.

First year medical student perceptions of physician advocacy and advocacy as a core competency: A qualitative analysis

PURPOSE

Medical societies have embraced advocacy as a core professional competency, but little is known about how entering medical students view physician advocacy. This study examined how first year medical students define advocacy, their motivations for and anticipated challenges to advocacy, and whether they believe advocacy should be a core competency.

METHOD

This study used a qualitative content analysis approach to analyze first year medical student narrative responses about physician advocacy. The analysis included the written responses of 95% of the first-year medical students at the University of California, San Francisco (UCSF) School of Medicine during two academic years.

RESULTS

Students shared consensus that physicians should advocate on behalf of their individual patients. Students had varying opinions on whether all physicians should engage in societal level advocacy and whether it should be a core competency in medical school. Students find several compelling reasons for physicians to engage in societal advocacy but nevertheless anticipate challenges to physician advocacy.

CONCLUSION

Given increasing consensus that advocacy is a core competency of physicians, providing medical students the skills to successfully engage in advocacy is increasingly important. Any new mandatory curricula will need to focus on how to engage learners with varied views on advocacy.

Prevalence and Characteristics of Advocacy Curricula in U.S. Medical Schools

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.

Practical Lessons for Teaching About Race and Racism: Successfully Leading Free, Frank, and Fearless Discussions

Successfully teaching about race and racism requires a careful balance of emotional safety and honest truth-telling. Creating such environments where all learners can thrive and grow together is a challenge, but a consistently doable one. This article describes 12 lessons learned within 4 main themes: ground rules; language and communication; concepts of social constructs, intersectionality, and bidirectional biases; and structural racism, solutions, and advocacy. The authors' recommendations for how to successfully teach health professions students about race and racism come from their collective experience of over 60 years of instruction, research, and practice. Proficiency in discussing race and addressing racism will become increasingly relevant as health care institutions strive to address the social needs of patients (e.g., food insecurity, housing instability) that contribute to poor health and are largely driven by structural inequities. Having interprofessional team-based care, with teams better able to understand and counteract their own biases, will be critical to addressing the social and structural determinants of health for marginalized patients. Recognizing that implicit biases about race impact both patients and health professions students from underrepresented racial/ethnic backgrounds is a critical step toward building robust curricula about race and health equity that will improve the learning environment for trainees and reduce health disparities.

Meaningful Patient Care Experiences for Minority Graduate School Students

BACKGROUND

Increasing numbers of underrepresented in medicine minority (URMM) physicians has garnered increased attention. Pipeline programs aid this effort and are designed to expose learners to the healthcare experience and strengthen academic preparedness. This paper describes the clinical experiences of students who participated in a bridge to medical school Master's Degree pipeline program at a community based medical school.

METHODS

Using qualitative methodology, the authors sought to explore the clinical experiences of three cohorts of graduate school pipeline students on a path to medical school. Thirty six master's level students responded to an evaluation of opened-ended questions at the conclusion of their clinical preceptorship. The responses to three open-ended questions were analyzed via the constant comparison analysis method.

RESULTS

The total number of clinical encounters during the clinical preceptorship over the three-year period was 633, a total of 144 h. The most common diagnoses seen were related to cardiovascular disease and diabetes. Three primary themes were identified regarding students' experiences in the pipeline program: connecting academic and clinical skills, learning the needs of and how to advocate for underserved patients and the need to increase exposure to underserved patient populations across specialties in medicine.

CONCLUSIONS

The clinical preceptorship linked academic knowledge with clinical skills and provided an avenue for learning about health disparities and patient advocacy for underserved patients. It also identified a need for increased exposure to underserved patient populations across medical specialties.