What knowledge is needed? Teaching undergraduate medical students to "go upstream" and advocate on social determinants of health

Community Collaboration to Develop a Curriculum on Settler Colonialism and the Social Determinants of Health

American Indian/Alaska Native (AI/AN) communities continue to experience health disparities and poor health outcomes, which are influenced by social determinants of health. The theory of settler colonialism provides a framework for understanding the structures that affect social determinants of health and the resulting health disparities. Western biomedicine and medical education have been implicated in perpetuating settler colonialism, and as a result Indigenous medical educators and leaders have called for increased education and understanding of the structural and social determinants of health affecting Indigenous populations. One important method is through community-based approaches to curriculum design. In collaboration with community leaders and experts, we identified the need for a curriculum on health in the context of settler colonialism, with a focus on resilience and community-directed efforts to improve wellness and care. Alongside Indigenous leaders and educators, we developed a unique curriculum focused on settler colonialism, the social determinants of health, and the assets inherent to the Native Nation where we work. Developed for non-Native learners and clinicians, the curriculum is designed to help provide context for the historical and political etiologies of health inequities experienced by the local community. Local educators helped shape a video lecture series associated with readings and experiential learning activities in 10 domains, providing an overview of settler colonialism and how it affects the social determinants of health. Our model of education draws upon the strengths and assets of communities and can improve health outcomes as well as learners' understandings of AI/AN-specific needs. We expect that our collaborative approach results in improved relationships among the Non-Native learners and providers and community members.

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.

The simulated newsroom: A novel educational innovation to teach advocacy skills to resident physicians

Need for Innovation

Advocacy is a key competency of Canadian residency education, yet physicians seldom engage with supraclinical advocacy efforts upon completion of training.

Objective of innovation

The objective was to equip participants with the knowledge and skills required to engage as physician-advocates in their communities using opinion writing as a tool.

Developmental process

We used Kern's six-step framework to leverage a common medical training method, simulation, to teach journalistic skills related to advocacy in our novel "simulated newsroom." Two emergency physicians with journalism training and workplace experience developed simulated newsroom workshops. The simulated newsroom consisted of participants acting as journalists and the expert facilitator acting as a news editor over two workshops. The participants were encouraged to write and workshop an article with colleagues.

Evaluation

Participants were invited to participate in a semistructured focus group and to submit their article for qualitative analysis. Focus group transcripts and written work were qualitatively analyzed to understand acceptability and feasibility and how participants might engage as future health advocates.

Outcomes

Twelve participants registered for the workshops and six attended. All six participated in the focus group; four submitted written work. The innovation bolstered participants' confidence in advocacy through the popular press and provided demonstrable skills in opinion writing. Participants valued the workshop as a voluntary component of residency education led by physicians with journalism expertise.

Discussion

The simulated newsroom may be an effective mechanism for increasing confidence and competence in advocacy writing.

Embedding Behavioral and Social Sciences across the Medical Curriculum: (Auto) Ethnographic Insights from Medical Schools in the United Kingdom

Key concepts and theories that are taught in order to develop cultural competency skills are often introduced to medical students throughout behavioral and social science (BSS) learning content. BSS represents a core component of medical education in the United Kingdom. In this paper, we examine, through (auto)ethnographic data and reflections, the experiences of BSS in medical education. The empirical data and insights have been collected in two ways: (1) through long-term ethnographic fieldwork among medical students and (2) via autoethnographic reflexive practice undertaken by the co-authors who studied, worked, examined, and collaborated with colleagues at different UK medical schools. Our findings indicate that despite BSS constituting a mandatory, essential component of the medical curriculum, medical students did not always perceive BSS as useful for their future practice as doctors, nor did they find it to be clinically relevant, in comparison to the biomedical learning content. We suggest that it is paramount for all stakeholders to commit to cultivating and developing cultural competency skills in medical education, through robustly embedding BSS learning content across the undergraduate medical curriculum. We conclude with recommendations for a wide range of educational practices that would ensure a full integration of BSS in the medical curriculum.

Structural competency in emergency medical education: A scoping review and operational framework

Objectives

Existing curricula and recommendations on the incorporation of structural competency and vulnerability into medical education have not provided clear guidance on how best to do so within emergency medicine (EM). The goal of this scoping review and consensus building process was to provide a comprehensive overview of structural competency, link structural competency to educational and patient care outcomes, and identify existing gaps in the literature to inform curricular implementation and future research in EM.

Methods

A scoping review focused on structural competency and vulnerability following Arksey and O'Malley's six-step framework was performed in concurrence with a multistep consensus process culminating in the 2021 SAEM Consensus Conference. Feedback was incorporated in developing a framework for a national structural competency curriculum in EM.

Results

A literature search identified 291 articles that underwent initial screening. Of these, 51 were determined to be relevant to EM education. The papers consistently conceptualized structural competency as an interdisciplinary framework that requires learners and educators to consider historical power and privilege to develop a professional commitment to justice. However, the papers varied in their operationalization, and no consensus existed on how to observe or measure the effects of structural competency on learners or patients. None of the studies examined the structural constraints of the learners studied.

Conclusions

Findings emphasize the need for training structurally competent physicians via national structural competency curricula focusing on standardized core competency proficiencies. Moreover, the findings highlight the need to assess the impact of such curricula on patient outcomes and learners' knowledge, attitudes, and clinical care delivery. The framework aims to standardize EM education while highlighting the need for further research in how structural competency interventions would translate to an ED setting and affect patient outcomes and experiences.