The societal responsibility of physicians to be health advocates, both at the population and patient level is necessary to positively influence public health and policy. Physicians must commit to learn about policy reform and the legislative process. Several regulatory physician organizations emphasize the importance of health. In addition, the Association of American Medical Colleges' (AAMC) Medical Schools Objectives Project, the Medical Council of Canada Qualifying Examination objectives and several Canadian medical schools outline advocacy as an objective. As a result, several US medical schools have designed and incorporated health advocacy into their curricula. Canadian medical schools, however, have been lagging behind. To address this deficiency, the University of Alberta and the University of Calgary hosted the 1st Annual Alberta Political Action Day (PAD) to engage medical students in advocacy and the policy making process. The two-day time requirement of PAD makes it an efficient model to incorporate health advocacy into the already demanding undergraduate medical curriculum. Canadian medical schools must follow the American example and further integrate initiatives such as PAD to teach health advocacy. The skills developed will enhance student's comprehension of how they can shape health policy and truly advocate for optimal patient care.
ObjectivesJournaling is a common non-pharmacological tool in the management of mental illness, however, no clear evidence-based guideline exists informing primary care providers on its use. We seek here to present this synthesis that may begin to inform future research and eventual evidence-based guideline development.DesignOf the 3797 articles retrieved from MEDLINE, EMBASE, PsycINFO, 20 peer-reviewed randomised control trials (31 outcomes) met inclusion criteria. These studies addressed the impact of a journaling intervention on PTSD, other anxiety disorders, depression or a combination of the aforementioned.Eligibility criteriaPeer reviewed, randomised control trials on the impact of journaling on mental illness were included.Information sourcesMEDLINE, EMBASE and PsycINFO.ResultsThe data are highly heterogeneous (control arm=I2 of 71.2%, intervention arm=I2 of 83.8%) combined with a B-level Strength of Recommendation Taxonomy recommendation. It was additionally found that there is a significant pre–post psychometric scale difference between control (−0.01, 95% CI −0.03 to 0.00) and intervention arms (−0.06, 95% CI −0.09 to −0.03). This 5% difference between groups indicates that a journaling intervention resulted in a greater reduction in scores on patient health measures. Cohen’s d effect size analysis of studies suggests a small to moderate benefit.ConclusionFurther studies are needed to better define the outcomes. Our review suggests that while there is some randomised control data to support the benefit of journaling, high degrees of heterogeneity and methodological flaws limit our ability to definitively draw conclusions about the benefit and effect size of journaling in a wide array of mental illnesses. Given the low risk of adverse effects, low resource requirement and emphasis on self-efficacy, primary care providers should consider this as an adjunct therapy to complement current evidence-based management.
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