A Qualitative Study of the Experiences and Factors That Led Physicians to Be Lifelong Health Advocates

How Are We Teaching Advocacy? A National Survey of Internal Medicine Residency Program Directors

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.

Navigating Challenging Conversations: The Interplay Between Inquiry and Knowledge Drives Preparation for Future Learning

Introduction

While some physicians hone their skills through informal learning in clinical practice, others do not. There is a lack of understanding of why some physicians seek improvement and how they use the workplace context to build their capabilities. Because physicians rarely pursue formal professional development activities to improve communication skills, examining physician-patient communication offers a powerful opportunity to illuminate important aspects of preparation for future learning in the workplace.

Methods

This qualitative observational study involved over 100 hours of observation of eight pediatric rehabilitation physicians as they interacted with patients and families at an academic teaching hospital in 2018-2020. Detailed field notes of observations, post-observation interviews, and exit interviews were the data sources. Data collection and analysis using a constructivist grounded theory approach occurred iteratively, and themes were identified through constant comparative analysis.

Results

Through their daily work, experienced physicians employ 'habits of inquiry' by constantly seeking a better understanding of how to navigate challenging conversations in practice through monitoring and attuning to situational and contextual cues, taking risks and navigating uncertainty while exploring new and varied ways of practicing, and seeking why their strategies are successful or not.

Discussion

Engaging in communication challenges drives physician learning through an interplay between habits of inquiry and knowledge: inquiry into how to improve their communication supported by existing conceptual knowledge to generate new strategies. These 'habits of inquiry' prompt continual reinvestment in problem solving to refine existing knowledge and to build new skills for navigating communication challenges in practice.

Grappling with key questions about assessment of the Health Advocate role

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.

Incorporating Health Policy and Advocacy Curricula Into Undergraduate Medical Education in the United States

Physicians serve as crucial advocates for their patients. Undergraduate medical education (UME) must move beyond the biomedical model, built upon the perception that health is defined purely in the absence of illness, to also incorporate population health through health policy, advocacy, and community engagement to account for structural and social determinants of health. Currently, the US guidelines for UME lack structured training in health policy or advocacy, leaving trainees ill-equipped to assume their role as physician-advocates or to engage with communities. There is an undeniable need to educate future physicians on legislative advocacy toward improving the social determinants of health through the creation of evidence-based health policy, in addition to training in effective techniques to engage in partnership with the communities in which physicians serve. The authors of this article also present curricular case studies around two programs at their institution that could be used to implement similar programs at other US medical schools.

Health advocacy among medical learners: Unpacking contextual barriers and affordances

INTRODUCTION

Learners and physicians are expected to practice as health advocates in Canadian contexts, but they rarely feel competent to practice this critical role when they complete their training. This is in part because advocacy is seen as "going above and beyond" routine practice and pushing the boundaries of systems that are resistant to change. Medical learning contexts are rife with barriers to learning about and practicing advocacy, and there is now a need to understand how contexts impact advocacy.

METHODS

Using constructivist grounded theory study, we generated data through individual and group interviews with medical learners to explore the barriers and facilitators to advocacy in a variety of learning/practice contexts. We used purposeful and theoretical sampling to ensure that diverse learning contexts and learners who had different views on advocacy were represented. We constructed a theoretical model to understand advocacy decision-making through cycles of initial, focused and theoretical coding, using constant comparative analysis.

RESULTS

Learners' thinking about health advocacy was framed by their own unique knowledge and beliefs, as well as their institutional and organisational contexts. With these influences in mind, learners made decisions about when to advocate within a local decision-making context, guided by affordances and barriers to advocacy involved in their perceptions of the patient, their own social position, resources available and social norms.

CONCLUSIONS

This framework highlights critical aspects of context that influence learners' ability to learn about and practice as health advocates. If we are to adequately prepare learners for this important work, we must address aspects of their learning and practice contexts that make this work daunting, and we offer learners the tools required to intervene in contexts that do not support their efforts.

Are Australian junior doctors failing to act as health advocates? A qualitative analysis

OBJECTIVE

To explore junior doctors' attitudes towards and experiences of health advocacy practice and teaching in Australia.

METHODS

Semi-structured interviews were conducted with 15 junior doctors across Australia. Data were thematically analysed.

RESULTS

Three themes were identified: i) participants inconsistently understood and practised health advocacy, with many failing to conduct any advocacy work; ii) distinct factors motivated and enabled participants to undertake health advocacy; however, these were largely unrelated to any formal medical education; iii) the current medical workplace and education system is non-conducive to health advocacy practice given the numerous barriers faced by junior doctors when engaging with health advocacy.

CONCLUSIONS

Health advocacy is generally poorly taught, weakly understood, and rarely performed despite being one of the four core graduate competencies of the Australian Medical Council (AMC). The AMC must clearly define health advocacy and its scope in their outcome statements, and this must be translated into medical education curricula and advocacy opportunities in the workplace.

IMPLICATIONS FOR PUBLIC HEALTH

Doctors are well-placed to act as public health advocates, yet they are denied the encouragement and training to do so. With the growing burden of complex and sensitive public health issues, junior doctors should be trained and encouraged in health advocacy.

Dental student's perceptions and experience treating adults with developmental disabilities

OBJECTIVES

The objective of this study was to investigate the perceptions and experiences of dental students with regards to treating adults with developmental disabilities (AWDDs).

METHODS

Semi-structured interviews were conducted with three groups of participants: experts who extensively work with AWDDs (n = 3), students who had no clinical training to treat AWDDs (n = 3), and students who had completed their clinical training to treat AWDDs (n = 8). One-on-one interviews were conducted in-person or via video call with each participant. Interviews were transcribed, coded, and analyzed for themes.

RESULTS

Experts described their motivations for working with AWDDs. Students in both groups identified the challenges of working with AWDDs and highlighted the impact of the informal curriculum as well as the increased importance of clinical training. Students who had received clinical training described the clinical rotation as a transformative learning experience that instilled a sense of health advocacy. There was alignment of themes between all three groups in terms of skills desired, acquired, and required to work with AWDDs; however, the students who had received clinical training and the experts differed on their opinion of the relative importance of the skills they developed.

CONCLUSIONS

The alignment of perceptions between students and experts is promising and demonstrates the successes of the existing curriculum. The misalignment between students and experts highlights areas in the curriculum that can be improved through adjustments and augmentation.

Navigating the uncertainty of health advocacy teaching and evaluation from the trainee's perspective

BACKGROUND

There may be no competency more shrouded in uncertainty than health advocacy (HA), raising questions about the robustness of advocacy training in postgraduate medical education. By understanding how programs currently train HA, we can identify whether trainees' learning needs are being met.

METHODS

From 2017 to 2019, we reviewed curricular documents across nine direct-entry specialties at all Ontario medical schools, comparing content for the HA and communicator roles to delineate role-specific challenges. We then conducted semi-structured interviews with trainees (n = 9) and faculty (n = 6) to review findings and discuss their impact. Data were analyzed using thematic content analysis.

RESULTS

Curricular documents revealed vague objectives and ill-defined modes of assessment for both intrinsic roles. This uncertainty was perceived as more problematic for HA, in part because HA seemed both undervalued in, and disconnected from, clinical learning. Trainees felt that the onus was on them to figure out how to develop and demonstrate HA competence, causing many to turn their learning attention elsewhere.

DISCUSSION

Lack of curricular focus seems to create the perception that advocacy isn't valuable, deterring trainees-even those keen to become competent advocates-from developing HA skills. Such ambivalence may have troubling downstream effects for both patient care and trainees' professional development.

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.

Exploring patients' and physicians' perspectives about competent health advocacy

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.

The Missing Chapter: The Education of Surgery and Anesthesiology Trainees as Civic Advocates

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.

Motivating medical students for social accountability in medical schools

INTRODUCTION

As health professionals, physicians are accountable for their professional practice.  The aim of this study was to explain the medical students' motivation to attain social accountability in medical schools, based on the experience of both students and faculties.

METHODS

We conducted a qualitative conventional content analysis research in Shiraz University of medical sciences in Iran since 2018 through purposive, snowball sampling. The data were collected through semi-structured interviews with 35 participants i.e., medical students and teachers. Coding was carried out by conventional content analysis.

RESULTS

We drew four themes and ten related subthemes and the central variable explains the motivation of medical students toward social accountability and makes a link among the subthemes, was purposeful beliefs and behavior. The key dimensions during motivational process which generated the social accountability development in medical students consisted of social culture of medicine, medical school reality, teaching and learning strategy and creating purposeful beliefs and behavior. Also, eight subthemes of individual motivation, content motivation process motivation, attending to the outcomes of the curriculum, traditional routine centered curriculum, observational learning, role modeling, hidden curriculum, respect for social values and norms and benefitting the society emerged which explain the process of motivate for social accountability by creating purposeful beliefs and behavior in medical students.

CONCLUSIONS

The core variable of motivation toward social accountability must be reflected in future developmental programs, curriculum planning and training general physicians. In other words, the best efforts for purposeful beliefs and behavior in medical students, must be made to improve motivation toward social accountability.

Addressing the health advocate role in medical education

The health advocate role is an essential and underappreciated component of the CanMEDs competency framework. It is tied to the concept of social accountability and its application to medical schools for preparing future physicians who will work to ensure an equitable healthcare system. Student involvement in health advocacy throughout medical school can inspire a long-term commitment to address health disparities. The Social Medicine Network (SMN) provides an online platform for medical trainees to seek opportunities to address health disparities, with the goal of bridging the gap between the social determinants of health and clinical medicine. This online platform provides a list of health advocacy related opportunities for addressing issues that impede health equity, whether through research, community engagement, or clinical care.First implemented at the University of British Columbia, the SMN has since expanded to other medical schools across Canada. At the University of Ottawa, the SMN is being used to augment didactic teachings of health advocacy and social accountability. This article reports on the development and application of the SMN as a resource for medical trainees seeking meaningful and actionable opportunities to enact their role as health advocates.

Street Medics: An innovative learning opportunity for UK medical students in a primary care outreach setting

It is well known that recruitment into general practice (GP) is low, particularly in deprived areas. Undergraduate medical students are encouraged to learn about health inequalities.However, teaching on this area has been perceived by some as uninspiring. Innovative teaching opportunities can engage students but more research is needed regarding exposure to deprived inner-city settings. Street Medics is an extra-curricular, educational initiative which enables students to join GPs doing street-outreach work. The aim of the study was to understand what motivates undergraduate medical students to engage with Street Medics and the impact of the experience. Focus group data were collected and thematically analysed. Motivating factor themes: appetite to explore; previous exposure including observation of perceived sub-optimal care to marginalised patients; perceived lack of exposure personally and in undergraduate teaching. Experience and impact themes: increased understanding of social determinants of health; change in perception; influence on career intentions; desire to incorporate into curriculum. Opportunities like Street Medics can supplement the undergraduate curriculum and not only challenge students' perceptions of marginalised patients but also ignite their enthusiasm for pursuing GP. By understanding the factors driving students' engagement in innovative educational opportunities, effective methods can be shared across undergraduate courses.

The state of health advocacy training in postgraduate medical education: a scoping review

CONTEXT

Health advocacy is an essential component of postgraduate medical education, and is part of many physician competency frameworks such as the Canadian Medical Education Directives for Specialists (CanMEDS) roles. There is little consensus about how advocacy should be taught and assessed in the postgraduate context. There are no consolidated guides to assist in the design and implementation of postgraduate health advocacy curricula.

OBJECTIVES

This scoping review aims to identify and analyse existing literature pertaining to health advocacy education and assessment in postgraduate medicine. We specifically sought to summarise themes from the literature that may be useful to medical educators to inform further health advocacy curriculum interventions.

METHODS

MEDLINE, Embase and ERIC were searched using MeSH (medical student headings) and non-MeSH search terms. Additional articles were found using forward snowballing. The grey literature search included Google and relevant stakeholder websites, regulatory bodies, physician associations, government agencies and academic institutions. We followed a stepwise scoping review methodology, followed by thematic analysis using an inductive approach.

RESULTS

Of the 123 documents reviewed in full, five major themes emerged: (i) conceptions of health advocacy have evolved towards advocating with rather than for patients, communities and populations; (ii) longitudinal curricula were less common but appeared the most promising, often linked to scholarly or policy objectives; (iii) hands-on, immersive opportunities build competence and confidence; (iv) community-identified needs and partnerships are increasingly considered in designing curriculum, and (v) resident-led and motivated programmes appear to engage residents and allow for achievement of stated outcomes. There remain significant challenges to assessment of health advocacy competencies, and assessment tools for macro-level health advocacy were notably absent.

CONCLUSIONS

There is considerable heterogeneity in the way health advocacy is taught, assessed and incorporated into postgraduate curricula across programmes and disciplines. We consolidated recommendations from the literature to inform further health advocacy curriculum design, implementation and assessment.

Patient advocacy in nursing: A concept analysis

Background:

The concept of patient advocacy is still poorly understood and not clearly conceptualized. Therefore, there is a gap between the ideal of patient advocacy and the reality of practice. In order to increase nursing actions as a patient advocate, a comprehensive and clear definition of this concept is necessary.

Research objective:

This study aimed to offer a comprehensive and clear definition of patient advocacy.

Research design:

A total of 46 articles and 2 books published between 1850 and 2016 and related to the concept of patient advocacy were selected from six databases and considered for concept analysis based on Rodgers’ evolutionary approach.

Ethical considerations:

This study was approved by the Research Ethics Committee of Tarbiat Modares University.

Findings:

The attributes of patient advocacy are safeguarding (track medical errors, and protecting patients from incompetency or misconduct of co-workers and other members of healthcare team), apprising (providing information about the patient’s diagnosis, treatment, and prognosis, suggesting alternatives of healthcare, and providing information about discharge program), valuing (maintaining self-control, enabling patients to make decisions freely, maintaining individualization and humanity, maintaining patient privacy, and acting in the patients’ values, culture, beliefs, and preferences), mediating (liaison between patients, families, and healthcare professionals, being patients’ voice, and communicate patient preferences and cultural values to members of the healthcare team), and championing social justice in the provision of healthcare (confronting inappropriate policies or rules in the healthcare system, identifying and correcting inequalities in delivery of health services, and facilitating access to community health services and health resources).

Discussion and conclusion:

The analysis of this concept can help to develop educational or managerial theories, design instruments for evaluating the performance of nurses in patient advocacy, develop strategies for enhancing patient advocacy, and improve the safety and quality of nursing care in the community and healthcare system.

Three-Tiered Advocacy: Using a Longitudinal Curriculum to Teach Pediatric Residents Advocacy on an Individual, Community, and Legislative Level

BACKGROUND

Pediatricians play a critical role as health advocates. Teaching residents to advocate for their patients on an individual, community, and legislative level is a priority for residency training programs. This study examined the effects of a longitudinal curriculum teaching 3-tiered advocacy on pediatric residents' attitudes, knowledge, and practice.

METHODS

This was a prospective pre- and postintervention study using an anonymous survey of pediatric residents (N = 78) in an urban academic children's hospital. The survey assessed advocacy on an individual level through comfort and experience in discussing social determinants of health (SDH), on a community level through comfort and practice referring patients to community resources, and on a legislative level through comfort and practice with legislative advocacy. Descriptive statistics and chi-square tests were used to analyze the data.

RESULTS

Postimplementation, pediatric residents reported the curriculum changed their clinical practice (66%), encouraged them to take a more in-depth social history (46%), and helped them guide patients to more community resources (38%). Comfort in discussing SDH with patients in the ambulatory clinic increased (27% vs 76%; P = .001). Reported frequency in inquiring about SDH significantly improved in the following areas: income (39% vs 60%; P = .025), education (71% vs 93%; P = .008), and legal issues (13% vs 26%; P = .012).

CONCLUSIONS

Most of the residents reported that the curriculum changed their clinical practice. Residents reported knowledge and comfort with advocating for their patients on an individual level improved. However, there was no significant difference on the community or legislative level. This curriculum raised awareness and armed residents with practical skills to be health advocates on an individual level. Further research is needed to explore effective means of creating 3-tiered advocates.

Choosing a women's health career

BACKGROUND

In 2005, in response to a decline in residency applications in obstetrics and gynecology (OB GYN), the American College of Obstetrics and Gynecology Presidential Task Force outlined strategies for attracting medical students to OB GYN. Application rates have increased since then, but little is known about which interventions are effective. We aimed to identify modifiable and nonmodifiable variables that may contribute to students choosing OB GYN for their careers; this information could be used to inform curriculum design, faculty development, and innovative exposures to women's health.

METHODS

This qualitative study received institutional review board approval. Eligible participants were students who applied or recently matched into OB GYN residency programs from the class of 2014-2016 at our institution. Students were interviewed with open-ended questions and a Likert-type survey. Thematic analysis was performed.

RESULTS

Ten qualitative interviews were completed and analyzed. Intrinsic themes such as the potential for a meaningful job in women's health, advocacy for women, or empowerment of women were identified as factors contributing to participant career choice. Extrinsic themes such as positive impressions during the clinical clerkship and welcoming teams were also identified. Most students indicated that the clerkship was the most influential experience.

CONCLUSIONS

Participants identified important events, including some that even preceded medical school that guided them toward OB GYN. The data guide us to consider the importance of emphasizing the unique combination of characteristics in OB GYN and improving the learning environment in the clerkship as a way to encourage student recruitment.

Please don't make us write an essay! Reflective writing as a tool for teaching health advocacy to medical students

Health advocacy is an important role for every physician. However, there is no consensus on the best methods to teach this critical medical competency. In 2014, Memorial University of Newfoundland instituted a health advocacy essay as part of the evaluation of clinical clerks during their paediatrics rotation. As the paediatric clerkship discipline coordinator, I evaluate these essays. In their essays, students describe opportunities for advocacy in children's health, experiences during the rotation and they provide their reflections on applying their new knowledge. Importantly, students frequently report that the exercise has furthered their understanding of this important role. In this opinion piece, I reflect on what the students and I have learned through this process, and discuss that reflective essays, like the one that our program has initiated, may play a valuable role in making future physicians more mindful of the opportunities for advocacy in the area of children's health.

[Sexual and reproductive health in Roma women: the family planning programme of Polígono Sur in Seville (Spain)]

OBJECTIVE

To describe the challenges, resources and strategies of the staff of the family planning programme of the Polígono Sur Healthcare Centre in Seville (Spain) in their care of Roma women.

METHOD

This is a descriptive study in which in-depth interviews and discussion groups were held with all programme professionals, including a documentary review of the programme. The information was analyzed based on the Roma Health Integration Policy Index, a tool that evaluates the entitlement, accessibility, sensitivity and capacity for change of health programmes for the Roma population.

RESULTS

The professionals encountered multiple challenges to implement the family planning programme with Roma women due to the characteristics of the users and the low sensitivity of the programme towards them. The absence of specific actions for Roma women within the family planning programme, agreed to by the healthcare district, obliges professionals to develop adaptations and strategies to ensure quality sexual and reproductive health services for their users.

CONCLUSIONS

It is necessary to adapt sexual and reproductive health programmes targeted at Roma women by (a) detecting, evaluating, systematizing and disseminating good practices, (b) developing actions that address the multiple vulnerabilities of Roma women, (c) acknowledging professionals who advocate for the health of these women within their organizations, and (d) promoting reproductive justice as the goal of these programmes.

The essential role of physician as advocate: how and why we pass it on

There is consensus amongst regulatory and certifying associations that the role of physician as advocate is a fundamental competency for Canadian physicians. Understanding what advocacy is and looks like in daily practice is integral to achieving this competency. Identifying barriers and exploring how we as physicians acquire the skills of advocacy are discussed. The current state of advocacy in medical education is reviewed as the starting point for exploring how best to foster the skills of physician as advocate.

Using critical consciousness to inform health professions education : A literature review

PURPOSE

To explore how, in health professions education (HPE), the concept of critical consciousness has been defined and discussed, and to consider and suggest how critical pedagogy could be applied in practice. This exploration responds to increasing calls in the literature for HPE to foster compassionate care and social consciousness through the social sciences and humanities.

METHOD

The authors searched Medline/PubMed, ERIC and Web of Science for articles focusing on critical consciousness and/or critical pedagogy involving health professions. A thematic analysis aimed to identify key themes of critical consciousness in HPE literature.

RESULTS

The authors included 30 papers in their review. Key themes related to defining and discussing core attributes of critical consciousness in HPE were: 1) appreciating context in education and practice; 2) illuminating power structures; 3) moving beyond 'procedural'; 4) enacting reflection; and 5) promoting equity and social justice.

CONCLUSIONS

Critical consciousness may inform an appropriate critical pedagogy for fostering compassionate, humanistic, socially conscious health professionals who act as agents of change. While the authors share critical teaching practices for educators, considerable care must be taken in efforts to use critical pedagogy within the current structures of HPE programmes. The authors suggest attending to the philosophical and theoretical origins of critical consciousness and those of the dominant models of contemporary HPE (e. g. competency-based approaches) in order to ensure the tenets of critical pedagogy can be enacted authentically.