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Moledina A, Ruller S, Halman S, Ying Y. Assessing resident experience of a new experiential learning health advocacy curriculum: a mixed methods study. BMC MEDICAL EDUCATION 2024; 24:988. [PMID: 39261820 PMCID: PMC11391829 DOI: 10.1186/s12909-024-05961-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/27/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Health Advocacy is considered one of the most difficult skills to teach. Many medical learners feel ill-equipped in social competencies and identify it as a significant gap in their medical training. Experiential learning has recently been emerging as a more effective method to teach health advocacy. The Post Graduate Medical Education (PGME) Health Advocacy Day is a new experiential learning curriculum designed to teach important competencies of health advocacy and social accountability to post-graduate medical residents at the University of Ottawa in Ottawa, Canada. The objective of this mixed-methods study was to assess resident experiences. METHODS Second-year trainees from all adult residency programs attended the Advocacy Day as part of a mandatory academic day. All participants completed a mandatory pre-and post-session quiz to assess knowledge of key topics before and after the course. We also distributed a voluntary survey to all participants and invited residents to participate in semi-structured interviews to provide feedback on the course. We used descriptive statistics to analyze quiz scores and survey results and conducted a paired t-test of pre and post-test quiz scores. We also performed a thematic analysis of qualitative feedback, specifically survey comments and semi-structured interviews. RESULTS One hundred and eighty-three residents participated in the Advocacy Day and 112 (61.2%) completed the post-course survey. Ten residents volunteered to be interviewed. Respondents were generally satisfied by the session and felt it was of good quality. Most residents felt the course enhanced their ability to advocate for individual patients or communities (N = 80; 71.5%) and understand patients and families' lived experience with illness (N = 87; 77.5%). Most residents also felt the course improved their knowledge of the impact of social determinants of health (N = 91; 81.2%) and increased their awareness of local resources that can support patients and their families (N = 88; 78.3%). Visiting community sites in-person and meeting persons with lived experiences were highlighted as the most valuable components of the course. CONCLUSION Experiential learning can be integrated within post-graduate medical curricula to teach health advocacy competencies. Future studies should examine the longitudinal impact of the curricula, to determine whether shifts in perspectives persist over time.
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Affiliation(s)
- Aliza Moledina
- Department of Medicine, University of Ottawa, 501 Smyth Road, K1H8L6, Ottawa, ON, Canada.
- Division of General Internal Medicine, The Ottawa Hospital, Ottawa, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Sydney Ruller
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Samantha Halman
- Department of Medicine, University of Ottawa, 501 Smyth Road, K1H8L6, Ottawa, ON, Canada
- Division of General Internal Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Yvonne Ying
- Department of Surgery, University of Ottawa, Ottawa, Canada
- Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada
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Verhees MJM, Landstra AM, Engbers R, Van De Pol MHJ, Huijbregts R, Van Meggelen RA, Kuijer-Siebelink W, Laan RFJM. Designing a Workplace-Based Learning Environment for Learning Health Promotion: A Design-Based Research. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:357-367. [PMID: 38948402 PMCID: PMC11212777 DOI: 10.5334/pme.1203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/24/2024] [Indexed: 07/02/2024]
Abstract
Introduction The healthcare landscape has a growing emphasis on health promotion (HP), which makes HP important in the training of future physicians. This study employed design-based research to develop a clerkship focused on HP and to outline design principles for shaping workplace learning environments to promote HP learning. Methods We evaluated a nursing-home clerkship designed at Radboud University Medical Center in the Netherlands, and refined it over three rounds. Data collection involved individual and group interviews with students and supervisors, as well as observations during clerkship-related meetings and activities. These interactions also facilitated the exchange of perspectives between participants and generation of new design ideas, fostering co-creation of the clerkship design. Data were analyzed through iterative thematic inquiry to inform new design choices and develop design principles. Results Evolved clerkship designs included an app for capturing practice experiences to discuss in relation to students' professional roles, loosening the strict assessment structure, and collaborative creation of a practice assignment about 'Positive Health'. We constructed four design principles, including: to question and discuss students' professional identity, provide concrete and meaningful assignments, aim for a peer-learner role for supervisors, and foster co-creation of the workplace learning environment. Discussion Our design principles support the design of workplace-based learning for HP, a subject that is novel within healthcare practice. We find that co-creation of workplace-based learning, which requires embracing uncertainty, is pivotal in this context, for students, practitioners, and educational institutions.
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Affiliation(s)
- Myrthe J. M. Verhees
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anneke M. Landstra
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Netherlands
- Rijnstate, Arnhem, Netherlands
| | - Rik Engbers
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marjolein H. J. Van De Pol
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
| | - Renske Huijbregts
- Radboud University, she was an intern at Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Roos A. Van Meggelen
- Radboud University, she was an intern at Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wietske Kuijer-Siebelink
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Netherlands
- HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Roland F. J. M. Laan
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, Netherlands
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Puschel K, Thompson B, Rioseco A, Leon A, Goic C, Fuentes I, Vescovi Z. Cancer advocacy in residency education: From principles to competencies. J Cancer Policy 2024; 40:100470. [PMID: 38479645 DOI: 10.1016/j.jcpo.2024.100470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION The global cancer burden is increasing. Current global evidence indicates there will be a 47% rise of cancer cases for the period 2020-2040. The cancer rate differential also is evident within countries and regions. Efforts have been used to reduce the health disparities; however, the inequity prevails. One potential way to help reduce the disparity is through advocacy by physicians. METHODS Two recent systematic review articles on advocacy among physicians note that physicians are unlikely to be taught advocacy in medical education, and also note there are no advocacy competencies or skill sets that are either taught or valued in medical education. We explore literature and develop a model to understand the components of advocacy in medical education, specifically in resident training. We follow the model's main components by examining principles of advocacy, relevant domains of advocacy, and competencies and values for advocacy education. RESULTS Four ethical principles of advocacy education are identified: beneficence, non-maleficence, autonomy, and justice. These principles must be applied in meaningful, culturally sensitive, respectful, and promotion of the well-being ways. Three domains are identified: the practice domain (provider-patient interaction), the community domain (provider-community collaboration), and the health policy domain (the larger social environment). Advocacy occurs differently within each domain. Finally, competencies in the form of knowledge, skills, and values are described. We present a table noting where each competency occurs (by domain) as well as the value of each knowledge and skill. POLICY SUMMARY The significance of including advocacy instruction in medical education requires a change in the current medical education field. Besides valuing the concept of including advocacy, principles, domains, and competencies of inclusion are critical. In summary, we encourage the inclusion of advocacy education in resident medical programs so physicians become competent medical providers at diverse levels of society.
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Affiliation(s)
- Klaus Puschel
- Department of Family and Community Medicine, School of Medicine, Universidad Católica de Chile, Chile; Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile.
| | - Beti Thompson
- Public Health Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Andrea Rioseco
- Department of Family and Community Medicine, School of Medicine, Universidad Católica de Chile, Chile; Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile
| | - Augusto Leon
- Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile; Department of Surgical Oncology, School of Medicine, Universidad Católica de Chile, Chile
| | - Carolina Goic
- Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile
| | - Isabella Fuentes
- Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile
| | - Zdenka Vescovi
- Centro de Prevención y Control de Cáncer (CECAN), FONDAP Chile, Chile
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Dhatt A, Fazelipour M, Sun T, Nemir A, Wilbur K. Health advocacy: A gulf between instruction and practice. CURRENTS IN PHARMACY TEACHING & LEARNING 2024; 16:335-342. [PMID: 38594170 DOI: 10.1016/j.cptl.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Systematic ways to teach health advocacy, an educational outcome for pharmacy graduates, is lacking. We developed a workshop to facilitate understanding and application of a novel structured framework for health advocacy and explored how pharmacy students enacted opportunities for health advocacy during subsequent outpatient experiential training. EDUCATIONAL ACTIVITY AND SETTING A two-hour workshop was introduced for year 2 students in 2019. Its content was organized around a health advocacy framework. With patient and faculty facilitators, students worked through examples characterized into the framework's four quadrants: 1) shared advocacy "with patients" at the individual- or 2) systems-level and 3) directed advocacy "for patients" at the individual-or 4) systems-level. We then conducted a longitudinal diary study asking pharmacy students (N = 23) to reflect on opportunities to practice health advocacy skills in community pharmacy practice. A systematic, multi-coder reflexive thematic analysis of diary entries was employed. FINDINGS Pharmacy students did not express a fulsome view of patient health advocacy and mischaracterized self-reported practice examples into inappropriate categories of the health advocacy framework. Most overemphasized usual pharmacist care as acts of health advocacy. No systems-level activities were undertaken, although isolated episodes of shared advocacy with patients were identified. SUMMARY Lasting impacts of a health advocacy workshop in our pharmacy curriculum were not widely apparent. While longer training periods in community pharmacy practice may yield more opportunities to develop and enact this role, gaps in student conceptualization of health advocacy and inabilities to practically observe and exercise system-level advocacy are ultimately problematic for patient care.
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Affiliation(s)
- Amninder Dhatt
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2508 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Mojan Fazelipour
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2508 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Tom Sun
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2508 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada
| | - Arwa Nemir
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2508 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Kerry Wilbur
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2508 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
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Schreidah CM, Robinson LN, Pham DX, Balaji D, Tinsley MS. The Case for Advocacy Curricula and Opportunities in Medical Education: Past Examples to Inform Future Instruction. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:482-486. [PMID: 38166320 DOI: 10.1097/acm.0000000000005615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
ABSTRACT With recent advances in understanding racial, socioeconomic, and mental health issues in medicine and their relation to policy and legislation, medical professionals are increasingly involved in local and national advocacy efforts. At the frontlines of these initiatives are medical students who, in addition to completing required coursework and clinical training, devote themselves to serving patients through civic participation. The burgeoning evidence concerning health care disparities and inequity, along with greater awareness of racial and socioeconomic discrimination, have made advocacy an essential aspect of many students' medical training. Every year, thousands of medical students join national medical advocacy organizations, in addition to regional, state, and local groups. Despite the rich history of medical student involvement in advocacy, there remains much speculation and skepticism about the practice as an essential component of the medical profession. From early initiatives pushing for national health insurance after World War II to encouraging antidiscrimination policies and practices, medical students have been collectively working to create change for themselves and their patients. Through efforts such as banning smoking on airplanes, creating safe syringe programs, and protesting against police brutality, many medical students work tirelessly in advocacy despite minimal educational support or guidance about the advocacy process. Given that medical student advocacy continues to grow and has shown measurable successes in the past, the authors believe that these efforts should be rewarded and expanded upon. The authors examine historical examples of medical student advocacy to suggest ways in which advocacy can be integrated into core medical school curricula and activities. They call attention to opportunities to support students' development of knowledge and skills to facilitate legislative change, expansion of interprofessional collaborations and credit, and curricular updates to promote social and health equity.
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Mizumoto J, Izumiya M, Horita S, Eto M. The Usage of the Term "Social" in Japanese Primary Care Literature. Cureus 2024; 16:e51972. [PMID: 38333451 PMCID: PMC10853026 DOI: 10.7759/cureus.51972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION There has been a growing recognition of the importance of incorporating a "social" perspective in primary care practice. However, the specific meaning of the term "social" in the context of primary care is often not clearly defined or explained in the literature. This study aims to explore the usage and interpretation of the term "social" in primary care discourse in Japan. METHODS We collected papers containing the term "social" ("shakai-teki" in Japanese) from 810 papers published between 2010 and 2022 in the Official Journal of the Japan Primary Care Association. Through abductive coding, we examined how the term was employed and the different meanings attributed to it. RESULTS The instances of using the term "social" were classified into five distinct categories: (i) non-medical, (ii) emphasizing the importance of topics, (iii) public as an object, (iv) connections with people who support health and well-being, and (v) structural inequities that are detrimental to health. Conclusion: The analysis revealed that the term "social" in the context of primary care discourse was multifaceted and characterized by ambiguity. To ensure effective communication and clarity in discussions, it is crucial for primary care professionals to have a clear understanding of the intended meaning and implications of the term "social."
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Affiliation(s)
- Junki Mizumoto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, University of Tokyo, Tokyo, JPN
| | - Masashi Izumiya
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, University of Tokyo, Tokyo, JPN
| | - Shoko Horita
- Department of Medical Education, School of Medicine, Teikyo University, Tokyo, JPN
| | - Masato Eto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, University of Tokyo, Tokyo, JPN
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Verhees MJM, Engbers R, Landstra AM, Bremer AE, van de Pol M, Laan RFJM, Assendelft WJJ. Workplace-based learning about health promotion in individual patient care: a scoping review. BMJ Open 2023; 13:e075657. [PMID: 37963689 PMCID: PMC10649380 DOI: 10.1136/bmjopen-2023-075657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE To outline current knowledge regarding workplace-based learning about health promotion in individual patient care. DESIGN Scoping review. DATA SOURCES PubMed, ERIC, CINAHL and Web of Science from January 2000 to August 2023. ELIGIBILITY CRITERIA We included articles about learning (activities) for healthcare professionals (in training), about health promotion in individual patient care and in the context of workplace-based learning. DATA EXTRACTION AND SYNTHESIS The studies were evaluated using a charting template and were analysed thematically using a template based on Designable Elements of Learning Environments model. RESULTS From 7159 studies, we included 31 that described evaluations of workplace-based learning about health promotion, around a variety of health promotion topics, for different health professions. In the articles, health promotion was operationalised as knowledge, skills or attitudes related to specific lifestyle factors or more broadly, with concepts such as health literacy, advocacy and social determinants of health. We assembled an overview of spatial and instrumental, social, epistemic and temporal elements of learning environments in which health promotion is learnt. CONCLUSIONS The studies included in our analysis varied greatly in their approach to health promotion topics and the evaluation of learning outcomes. Our findings suggest the importance of providing opportunities for health profession learners to engage in authentic practice situations and address potential challenges they may experience translating related theory into practice. Additionally, our results highlight the need for conscious and articulated integration of health promotion in curricula and assessment structures. We recommend the exploration of opportunities for health profession students, professionals and patients to learn about health promotion together. Additionally, we see potential in using participatory research methods to study future health promotion learning. STUDY REGISTRATION Open Science Framework, https://doi.org/10.17605/OSF.IO/6QPTV.
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Affiliation(s)
| | - Rik Engbers
- Radboudumc Health Academy, Radboudumc, Nijmegen, The Netherlands
| | - Anneke M Landstra
- Radboudumc Health Academy, Radboudumc, Nijmegen, The Netherlands
- Paediatrics, Rijnstate, Arnhem, The Netherlands
| | - Anne E Bremer
- Radboudumc Health Academy, Radboudumc, Nijmegen, The Netherlands
| | - Marjolein van de Pol
- Radboudumc Health Academy, Radboudumc, Nijmegen, The Netherlands
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
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Fazelipour M, Dhatt A, Sun T, Nemir A, Wilbur K. Pharmacy Students Practicing Health Advocate Competency Roles in Workplace-Based Training. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100118. [PMID: 37714657 DOI: 10.1016/j.ajpe.2023.100118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/25/2023] [Accepted: 04/05/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE Health advocacy competency roles are found in the educational outcomes of many health disciplines, yet their development is neglected in the professional curriculum and clinical learning environment. We explored how pharmacy students conceptualize health advocacy through their practice in workplace-based learning and any feedback they receive. METHODS We conducted a longitudinal diary study of Canadian pharmacy students completing Advanced Pharmacy Practice Experiences in hospital and community practices in their graduating year. At pre-determined intervals, 25 students recorded workplace-based activities they recognized as health advocacy and any feedback they received from supervisors, patients, or other staff. Written diary data from 180 records were analyzed by 5 researchers according to inductive content analysis steps and principles. RESULTS Pharmacy student records reflecting health advocacy roles were organized into 5 categories including, (1) disease prevention; (2) health promotion; (3) seamless care; (4) usual pharmacist care; and (5) professional advocacy. Although many activities were consistent with current competency role descriptions, they do not reflect educational outcomes associated with patient- or systems-level support necessary to address socio-political determinants of health. Although Advanced Pharmacy Practice Experience in training evaluation reports included scores for items related to health advocacy competency, few students confirmed receiving specific written or verbal feedback. CONCLUSION Pharmacy students construct health advocacy roles in workplace-based training through biomedical-oriented practices with little direct input offered by supervisors. Pharmacy educational outcomes require contemporary updates to health advocacy competency descriptions which offer examples for practical enactment at system-level and recommendations for feedback and assessment.
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Affiliation(s)
- Mojan Fazelipour
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Amninder Dhatt
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Tom Sun
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Arwa Nemir
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Kerry Wilbur
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada.
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Burm S, Cristancho S, Watling CJ, LaDonna KA. Expanding the advocacy lens: using photo-elicitation to capture patients' and physicians' perspectives about health advocacy. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:411-426. [PMID: 36214940 DOI: 10.1007/s10459-022-10162-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 09/03/2022] [Indexed: 05/11/2023]
Abstract
Heath advocacy (HA) remains a difficult competency to train and assess, in part because practicing physicians and learners carry uncertainty about what HA means and we are missing patients' perspectives about the role HA plays in their care. Visual methods are useful tools for exploring nebulous topics in health professions education; using these participatory approaches with physicians and patients might counteract the identified training challenges around HA and more importantly, remedy the exclusion of patient perspectives. In this paper we share the verbal and visual reflections of patients and physicians regarding their conceptualizations of, and engagement in 'everyday' advocacy. In doing so, we reveal some of HA's hidden dimensions and what their images uncovered about the role of advocacy in patient care. Constructivist grounded theory guided data collection and analysis. Data was collected through semi-structured interviews and photo-elicitation, a visual research method that uses participant generated photographs to elicit participants knowledge and experiences around a particular topic. We invited patients living with chronic health conditions (n = 10) and physicians from diverse medical and surgical specialties (n = 14) to self-select photographs representing their experiences navigating HA in their personal and professional lives. Both groups found taking photographs useful for revealing the nuanced and circumstantial factors that either enabled or challenged their engagement in HA. While patients' photos highlighted their embodiment of HA, physicians' photos depicted HA as something quite elusive or as a complicated and daunting task. Photo-elicitation was a powerful tool in eliciting a diversity of perspectives that exist around the HA role and the work advocates perform; training programs might consider using visuals to augment teaching for this challenging competency.
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Affiliation(s)
- Sarah Burm
- Continuing Professional Development and Division of Medical Education, Clinical Research Centre, C-104, Dalhousie University, 5849 University Ave, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Sayra Cristancho
- Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Christopher J Watling
- Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Kori A LaDonna
- Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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LaDonna KA, Kahlke R, Scott I, van der Goes T, Hubinette M. Grappling with key questions about assessment of the Health Advocate role. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:80-89. [PMID: 36998507 PMCID: PMC10042793 DOI: 10.36834/cmej.73878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
| | | | - Ian Scott
- University of British Columbia, British Columbia, Canada
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Mizumoto J, Mitsuyama T, Kondo S, Izumiya M, Horita S, Eto M. Defining the observable processes of patient care related to social determinants of health. MEDICAL EDUCATION 2023; 57:57-65. [PMID: 35953461 DOI: 10.1111/medu.14915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION An understanding of social determinants of health (SDH) and patients' social circumstances is recommended to deliver contextualised care. However, the processes of patient care related to SDH in clinical settings have not been described in detail. Observable practice activities (OPAs) are a collection of learning objectives and activities that must be observed in daily practice and can be used to describe the precise processes for professionals to follow in specific situations (process OPA.) METHODS: We used a modified Delphi technique to generate expert consensus about the process OPA for patient care related to SDH in primary care settings. To reflect the opinions of various stakeholders, the expert panel comprised clinical professionals (physicians, nurses, public health nurses, social workers, pharmacists and medical clerks), residents, medical students, researchers (medical education, health care, sociology of marginalised people), support members for marginalised people and patients. The Delphi rounds were conducted online. In Round 1, a list of potentially important steps in the processes of care was distributed to panellists. The list was modified, and one new step was added. In Round 2, all steps were acknowledged with few modifications. RESULTS Of 63 experts recruited, 61 participated, and all participants completed the Delphi rounds. A total of 14 observable steps were identified, which were divided into four components: communication, practice, maintenance and advocacy. The importance of ongoing patient-physician relationships and collaboration with professionals and stakeholders was emphasised for the whole process of care. DISCUSSION This study presents the consensus of a variety of experts on the process OPA for patient care related to SDHs. Further research is warranted to investigate how this Communication-Practice-Maintenance-Advocacy framework could affect medical education, quality of patient care, and patient outcomes.
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Affiliation(s)
- Junki Mizumoto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshichika Mitsuyama
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Kondo
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masashi Izumiya
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shoko Horita
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masato Eto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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