Health advocacy training: Why are physicians withholding life-saving care?

Abstract

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.

The teaching and learning of health advocacy in an Australian medical school

“…The examples provided were largely experiential learning opportunities, such as rural non-clinical placements and the interactive panel discussions involving expert patients and representatives of community-based organisations. These examples are consistent with North American studies suggesting that it is largely through “community health improvement clerkships”, 9 research projects, 10 health policy workshops 11 and opportunities to collaborate with politicians on local health issues 11 where students learn to be health advocates.…”

“…Nonetheless, additional studies have demonstrated that optimal training in advocacy requires practical “hands-on” experience. 8 , 11 , 12 …”

“…The medical schools of the University of Alberta and the University of Calgary (2011) conducted a two-day intensive course in HA, with one day of HA training and the second day involving smaller groups practising pitching a health issue to local politicians employing the HA skills they had learnt. 11 It proved an efficient exercise given the time limitations of an already full undergraduate curriculum. Furthermore, an American study in 2012 looked at the impact of a half-day advocacy experience by attending the National Advocacy Day as part of the American Medical Student Association’s convention in Washington, D.C. Pre- and post- surveys were used to assess the pre-medical and medical students’ views and knowledge of HA.…”

Implementing a Practical Global Health Curriculum: The Benefits and Challenges of Patient-Based Learning in the Community

“…There is growing concern among physicians and medical teachers that medical students have insufficient patient contact and their training is task-focused rather than patient-focused (1)(2)(3)(4). Too often they ask "what is the problem?"…”

Missing the target? Teaching undergraduate medical students to “go upstream” and advocate on social determinants of health

“…These sometimes do not focus on addressing health inequities. 9 Based on the current gaps in advocacy education-an identified basis of knowledge and skill, and a lack of attention to systemic and structural factors-we chose to develop an educational initiative based on Metzl and Hansen's Structural Competency paradigm. This initiative includes five intersecting knowledge and skill-sets, including recognizing the structures that shape clinical interactions, developing an extra-clinical language of structure, rearticulating "cultural" formulations in structural terms, observing and imagining structural interventions, and developing structural humility.…”