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De Leon E, Chebly KO, Girmay B, Altshuler L, Gonzalez CM, Greene RE. Addressing a Gap in Health Equity Education: A Qualitative Analysis of a Longitudinal GME Course. J Gen Intern Med 2025:10.1007/s11606-025-09511-9. [PMID: 40246752 DOI: 10.1007/s11606-025-09511-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 04/04/2025] [Indexed: 04/19/2025]
Abstract
BACKGROUND Graduate medical education (GME) on diversity, equity, and inclusion rarely teaches strategies for developing anti-racist mindsets and behaviors, and understanding of the impact of these programs and particular curricular components is lacking. OBJECTIVE To evaluate the format, content, and impact of a longitudinal anti-racism conference series (ARC) on resident physicians within an urban internal medicine program through a qualitative analysis, with the goal of informing the development and implementation of other evidence-based anti-racism curricula in graduate medical education (GME). DESIGN The ARC consisted of eight mandatory, 60-min virtual conferences held between August 2020 and June 2021 within an internal medicine residency program's primary care track sub-group. The conference's content synthesized previous anti-racism curricula, scholarly readings, and practical experiences, and emphasized internal reflection and behavior change. PARTICIPANTS Thirty internal medicine resident physicians and six faculty members. MAIN MEASURES Seven voluntary, semi-structured, hour-long focus groups were conducted to document resident perspectives on the ARC's format, content, and impact of the curriculum on learner's professional and personal development. Constructivist grounded theory was used to analyze resident responses. KEY RESULTS In total, 17/30 (57%) residents participated in focus groups. Analysis of course format, content, and impact revealed the following: (1) The most valued aspect of the course's instructional format was its perceived psychological safety. (2) Residents desired course content with more outward action steps than were offered. (3) Residents noted personal and professional impact across three main domains: intrapersonal, interpersonal, and institutional. CONCLUSIONS In this longitudinal GME internal medicine anti-racism curriculum, participants felt that the curriculum format provided safe spaces to engage with topics on systemic racism and patient care, but content lacked sufficient action-oriented strategies. The curriculum's impact was multi-dimensional and could be studied more deeply in the future through simulation or direct observation.
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Affiliation(s)
- Elaine De Leon
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Katherine Otto Chebly
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Blen Girmay
- Division of Geriatrics, Inova Health System, Fairfax, VA, USA
| | - Lisa Altshuler
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Cristina M Gonzalez
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Richard E Greene
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
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Mukhopadhyay B, Thambinathan V, Kinsella EA. Towards anti-racist futures: a scoping review exploring educational interventions that address systemic racism in post graduate medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2025; 30:359-381. [PMID: 38874647 PMCID: PMC11965230 DOI: 10.1007/s10459-024-10343-1] [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: 11/15/2023] [Accepted: 05/19/2024] [Indexed: 06/15/2024]
Abstract
Since 2020, brought to the forefront by movements such as Black Lives Matter and Idle No More, it has been widely acknowledged that systemic racism contributes to racially differentiated health outcomes. Health professional educators have been called to address such disparities within healthcare, policy, and practice. To tackle structural racism within healthcare, one avenue that has emerged is the creation of medical education interventions within postgraduate residency medical programming. The objective of this scoping review is to examine the current literature on anti-racist educational interventions, that integrate a systemic or structural view of racism, within postgraduate medical education. Through the identification and analysis of 23 papers, this review identified three major components of interest across medical interventions, including (a) conceptualization, (b) pedagogical issues, and (c) outcomes & evaluation. There were overlapping points of discussion and analysis within each of these components. Conceptualization addressed how researchers conceptualized racism in different ways, the range of curricular content educators chose to challenge racism, and the absence of community's role in curricular development. Pedagogical issues addressed knowledge vs. skills-based teaching, and tensions between one-time workshops and integrative curriculum. Outcomes and evaluation highlighted self-reported Likert scales as dominant types of evaluation, self-evaluation in educational interventions, and misalignments between intervention outcomes and learning objectives. The findings are unique in their in-depth exploration of anti-racist medical interventions within postgraduate medical education programming, specifically in relation to efforts to address systemic and structural racism. The findings contribute a meaningful review of the current state of the field of medical education and generate new conversations about future possibilities for a broader anti-racist health professions curriculum.
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Affiliation(s)
- Baijayanta Mukhopadhyay
- Office of Social Accountability and Community Engagement, Faculty of Medicine and Health Sciences, Institute of Health Sciences Education, McGill University, Montreal, QC, Canada.
| | - Vivetha Thambinathan
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
| | - Elizabeth Anne Kinsella
- Department of Equity, Ethics and Policy, Faculty of Medicine and Health Sciences, Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
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Raskob K, Ramanan RA, Lezak M, Negrete JE, Binder E, Addington-White J, Laponis R, Griffiths EP. Advocating with Community: A Community-Engaged Advocacy Curriculum for Internal Medicine Residents. J Gen Intern Med 2025; 40:113-118. [PMID: 39313667 PMCID: PMC11780006 DOI: 10.1007/s11606-024-09049-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 09/13/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND In 2022, the Accreditation Council for Graduate Medical Education updated its competencies for residents in all specialties to include health policy advocacy. A recent systematic review shows that while a growing number of residency curricula include policy advocacy, few programs join in policy advocacy efforts with community partners. AIM To create a community-engaged advocacy curriculum for residents that is part of a mutually beneficial partnership with community-based organizations (CBOs). SETTING A university-affiliated residency program and CBOs within a large US city. PARTICIPANTS Eighty internal medicine residents and local CBO clients and staff. PROGRAM DESCRIPTION The curriculum was delivered over 2 years and included advocacy skills sessions, service learning and reflection at the CBOs, and direct policy advocacy. PROGRAM EVALUATION Residents and CBO partners were surveyed to gather quantitative and qualitative data. Residents perceived that the program enhanced their confidence and skills in community engagement and policy advocacy. All CBO staff agreed that the partnership advanced the CBO's mission, residents' volunteering provided beneficial service, and residents had a meaningful impact on their advocacy efforts. DISCUSSION Our community-engaged advocacy curriculum successfully met its aims and has contributed to policy change. Future directions include building a statewide coalition of residents and CBOs.
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Affiliation(s)
- Kathleen Raskob
- Division of General Internal Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.
| | - Radhika A Ramanan
- Division of General Internal Medicine, University of California San Francisco, San Francisco, USA
| | | | | | | | - Joan Addington-White
- Division of General Internal Medicine, University of California San Francisco, San Francisco, USA
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Ryan Laponis
- Division of General Internal Medicine, University of California San Francisco, San Francisco, USA
| | - Elizabeth P Griffiths
- Division of General Internal Medicine, University of California San Francisco, San Francisco, USA
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Dresser C, Wiskel T, Giudice C, Humphrey K, Storr L, Balsari S. A Graduate Medical Education Fellowship in Climate Change and Human Health: Experience and Outcomes From the First 5 Years. J Grad Med Educ 2024; 16:129-134. [PMID: 39677895 PMCID: PMC11644595 DOI: 10.4300/jgme-d-24-00110.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/03/2024] [Accepted: 05/20/2024] [Indexed: 12/17/2024] Open
Abstract
Background Climate change is affecting health and health care, but most physicians lack formal training on climate change. There is a need for graduate medical education (GME) programs that prepare physician leaders to address its health impacts. Objective To describe the development and iterative piloting of a GME fellowship in climate change and health and to assess fellows' academic output and public engagement before and after fellowship matriculation. Methods A GME training program was developed and implemented at an emergency medicine department in a US teaching hospital in collaboration with affiliated academic centers. Participants consisted of emergency physicians from the United States and abroad. Program duration and format were adjusted to meet individual career goals. Outcomes assessed include program completion, postgraduation professional roles, and academic outputs and public engagement before and after fellowship matriculation (2019-2023), compared via paired t tests. Results Five fellows have matriculated; 2 have graduated, while 3 remain in training. Costs and in-kind support include salaries, faculty time, research support, travel to conferences, and tuition for a public health degree. Fellows averaged 0.26 outputs per month before matriculation (95% CI 0.01-0.51) and 2.13 outputs per month following matriculation (95% CI 0.77-3.50); this difference was significant via 2-tailed t test (alpha=.05, P=.01). Subanalyses of academic output and public engagement reveal similar increases. Following matriculation, 186 of 191 (97.4%) of outputs were related to climate change. Conclusions For the 5 fellows that have enrolled in this GME climate change fellowship, academic and public engagement output rates increased following fellowship matriculation.
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Affiliation(s)
- Caleb Dresser
- Caleb Dresser, MD, MPH, is Assistant Director, Fellowship in Climate Change and Human Health, Assistant Professor, Harvard Medical School, and Instructor, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Tess Wiskel
- Tess Wiskel, MD, is a Fellow, Climate Change and Human Health, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Catharina Giudice
- Catharina Giudice, MD, is a Fellow, Climate Change and Human Health, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kimberly Humphrey
- Kimberly Humphrey, MBBS, MPHTM, is Public Health Medical Consultant and Climate Change Lead, Health Protection and Regulation, South Australia Department for Health and Wellbeing, and Emergency Medicine Specialist, Northern Adelaide Local Health Network, Adelaide, South Australia
| | - Latoya Storr
- Latoya Storr, MD, is a Fellow, Disaster Medicine and Climate Change, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; and
| | - Satchit Balsari
- Satchit Balsari, MD, MPH, is Director, Fellowship in Climate Change and Human Health, Assistant Professor, Harvard Medical School, and Assistant Professor, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Basu G, Stojicic P, Goldman A, Shaffer J, McCormick D. Health Professionals Organizing for Climate Action: A Novel Community Organizing Fellowship. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:408-413. [PMID: 38228058 PMCID: PMC10980566 DOI: 10.1097/acm.0000000000005637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
PROBLEM Climate change is a public health and health equity crisis. Health professionals are well positioned to advance solutions but may lack the training and self-efficacy needed to achieve them. APPROACH The Center for Health Equity Education and Advocacy at Cambridge Health Alliance, a Harvard Medical School Teaching Hospital, developed a novel, longitudinal fellowship that taught health professionals about health and health equity effects of climate change, as well as community organizing practices that may help them mitigate these effects. The fellowship cohort included 40 fellows organized into 12 teams and was conducted from January to June 2022. Each team developed a project to address climate change and received coaching from an experienced community organizer coach. Effects of the fellowship on participants' knowledge, skills, and attitudes were evaluated using pre- and postfellowship surveys. OUTCOMES Surveys were analyzed for 38 of 40 (95%) participants who consented to the evaluation and completed both surveys. Surveys used a 7-point Likert scale for item responses. McNemar's test for paired data was used to assess changes in the proportion of respondents who agreed ("somewhat agree"/"agree"/"strongly agree") with statements in pre- vs postfellowship surveys. Statistically significant improvements were found for 11 of the 17 items assessing knowledge, skills, and attitudes. Participants' views of the fellowship and its effects were assessed through additional items in the postfellowship survey. Most respondents agreed that the fellowship increased their knowledge of the connections between climate change and health equity (32/38, 84.2%) and prepared them to effectively participate in a community organizing campaign (37/38, 94.7%). Each of the 12 groups developed climate health projects by the fellowship's end. NEXT STEPS This novel fellowship was well received and effective in teaching community organizing to health professionals concerned about climate change. Future studies are needed to assess longer-term effects of the fellowship.
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Henry TL, Rollin FG, Olakunle OE. How to Create a Diversity, Equity, and Inclusion Curriculum: More Than Checking a Box. Ann Fam Med 2024; 22:154-160. [PMID: 38527815 PMCID: PMC11237195 DOI: 10.1370/afm.3078] [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: 06/24/2023] [Revised: 09/30/2023] [Accepted: 10/16/2023] [Indexed: 03/27/2024] Open
Abstract
We are beginning to accept and address the role that medicine as an institution played in legitimizing scientific racism and creating structural barriers to health equity. There is a call for greater emphasis in medical education on explaining our role in perpetuating health inequities and educating learners on how bias and racism lead to poor health outcomes for historically marginalized communities. Diversity, equity, and inclusion (DEI; also referred to as EDI) and antiracism are key parts of patient care and medical education as they empower health professionals to be advocates for their patients, leading to better health care outcomes and more culturally and socially humble health care professionals. The Liaison Committee on Medical Education has set forth standards to include structural competency and other equity principles in the medical curriculum, but medical schools are still struggling with how to specifically do so. Here, we highlight a stepwise approach to systematically developing and implementing medical educational curriculum content with a DEI and antiracism lens. This article serves as a blueprint to prepare institution leadership, medical faculty, staff, and learners in how to effectively begin or scale up their current DEI and antiracism curricular efforts.
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Affiliation(s)
- Tracey L Henry
- Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Francois G Rollin
- Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
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Mateo CM, McCormick D, Connors C, Basu G. From Theory to Action: Evaluation of a Longitudinal Project-Based Antiracism Course for Post-Graduate Physicians. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241303643. [PMID: 39664509 PMCID: PMC11632890 DOI: 10.1177/23821205241303643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 11/11/2024] [Indexed: 12/13/2024]
Abstract
Objectives Few opportunities exist for postgraduate physicians to learn to address racism in their professional practice. We created a virtual, 5-session antiracism course that included the development of a formal action project to address racism at participants' home institution. Methods We delivered this curriculum virtually to 2 cohorts (2021 and 2022) of postgraduate physicians, nationally. The curriculum had 3 educational aims: (1) to increase knowledge on antiracism, (2) to increase comfort and engagement in discussing antiracism at home institutions, and (3) to increase self-efficacy to execute an institution-based project. Theory-informed practice, community building, and project-based learning were used to achieve our educational aims. We analyzed changes in these domains in addressing racism using matched 7-item Likert-scale questions from pre- and post-course surveys and the Wilcoxon signed rank test. We assessed perceptions and impacts of the course with post-course survey items using descriptive statistics. Results Forty-three of 50 participants (86%) who completed pre- and post-course surveys were included in the analysis. We found pre-post course increases in mean scores (converted from Likert scales), for all 15 paired questions. For example, we found improvements in understanding the historical context of racism in medical institutions (mean score change: 5.12 [SD 1.00] to 6.42 [SD 0.76], P < .001), comfort in talking to colleagues about racism (5.21 [SD 1.08] to 6.19 [SD 0.70], P < .001), and capacity to address racism in patient care at their home institution (4.51 [SD 1.35] to 5.56 [SD 0.91], P < 0.001). 93% reported the course increased the likelihood of working to address racism at their institution. Conclusion This project-based antiracism course for postgraduate learners increased self-reported knowledge of, comfort with, and self-efficacy in addressing racism and was well received by participants.
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Affiliation(s)
- Camila M. Mateo
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Danny McCormick
- Harvard Medical School, Boston, MA, USA
- Center for Health Equity Education and Advocacy, Cambridge Health Alliance, Cambridge, MA, USA
| | - Chrissie Connors
- Center for Health Equity Education and Advocacy, Cambridge Health Alliance, Cambridge, MA, USA
| | - Gaurab Basu
- Harvard Medical School, Boston, MA, USA
- Center for Health Equity Education and Advocacy, Cambridge Health Alliance, Cambridge, MA, USA
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Agrawal N, Lucier J, Ogawa R, Arons A. Advocacy Curricula in Graduate Medical Education: an Updated Systematic Review from 2017 to 2022. J Gen Intern Med 2023; 38:2792-2807. [PMID: 37340255 PMCID: PMC10507002 DOI: 10.1007/s11606-023-08244-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/15/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Advocacy is an integral component of a physician's professional responsibilities, yet efforts to teach advocacy skills in a systematic and comprehensive manner have been inconsistent and challenging. There is currently no consensus on the tools and content that should be included in advocacy curricula for graduate medical trainees. OBJECTIVE To conduct a systematic review of recently published GME advocacy curricula and delineate foundational concepts and topics in advocacy education that are pertinent to trainees across specialties and career paths. METHODS We conducted an updated systematic review based off Howell et al. (J Gen Intern Med 34(11):2592-2601, 2019) to identify articles published between September 2017 and March 2022 that described GME advocacy curricula developed in the USA and Canada. Searches of grey literature were used to find citations potentially missed by the search strategy. Articles were independently reviewed by two authors to identify those meeting our inclusion and exclusion criteria; a third author resolved discrepancies. Three reviewers used a web-based interface to extract curricular details from the final selection of articles. Two reviewers conducted a detailed analysis of recurring themes in curricular design and implementation. RESULTS Of 867 articles reviewed, 26 articles, describing 31 unique curricula, met inclusion and exclusion criteria. The majority (84%) represented Internal Medicine, Family Medicine, Pediatrics, and Psychiatry programs. The most common learning methods included experiential learning, didactics, and project-based work. Most covered community partnerships (58%) and legislative advocacy (58%) as advocacy tools and social determinants of health (58%) as an educational topic. Evaluation results were inconsistently reported. Analysis of recurring themes showed that advocacy curricula benefit from an overarching culture supportive of advocacy education and should ideally be learner-centric, educator-friendly, and action-oriented. DISCUSSION Combining core features of advocacy curricula identified in prior publications with our findings, we propose an integrative framework to guide design and implementation of advocacy curricula for GME trainees. Additional research is needed to build expert consensus and ultimately develop model curricula for disseminated use.
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Affiliation(s)
- Nupur Agrawal
- Division of Internal Medicine and Pediatrics, Department of Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA USA
| | - Jessica Lucier
- Palliative Care Program, Division of General Internal Medicine & Health Services Research, Department of Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA USA
| | - Rikke Ogawa
- UCI Libraries, University of California Irvine, Irvine, CA USA
| | - Abigail Arons
- Division of General Internal Medicine, Department of Internal Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA USA
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Aiello E, Perera K, Ade M, Sordé-Martí T. A case study on the use of Public Narrative as a leadership development approach for Patient Leaders in the English National Health Service. Front Public Health 2022; 10:926599. [PMID: 36187684 PMCID: PMC9521407 DOI: 10.3389/fpubh.2022.926599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/15/2022] [Indexed: 01/24/2023] Open
Abstract
Background In 2016 the National Health Service (NHS) England embraced the commitment to work for maternity services to become safer, more personalized, kinder, professional and more family-friendly. Achieving this involves including a service users' organizations to co-lead and deliver the services. This article explores how Public Narrative, a framework for leadership development used across geographical and cultural settings worldwide, can enhance the confidence, capability and skills of service-user representatives (or Patient Leaders) in the National Health Service (NHS) in England. Specifically, we analyse a pilot initiative conducted with one cohort of Patient Leaders, the Chairs of local Maternity Voices Partnerships (MVPs), and how they have used Public Narrative to enhance their effectiveness in leading transformation in maternity services as part of the NHS Maternity Transformation Programme. Methods Qualitative two-phase case study of a pilot training and coaching initiative using Public Narrative with a cohort of MVP Chairs. Phase 1 consisted of a 6-month period, during which the standard framework was adapted in co-design with the MVP Chairs. A core MVP Chair Co-Design Group underwent initial training and follow-up coaching in Public Narrative. Phase 2 consisted of qualitative data collection and data analysis. Results The study of this pilot initiative suggests two main ways in which Public Narrative can enhance the effectiveness of Patient Leaders in service improvement in general and maternity services in specific. First, training and coaching in the Public Narrative framework enables Patient Leaders to gain insight into, articulate and then craft their lived experience of healthcare services in a way that connects with and activates the underlying values of others ("shared purpose"), such that those experiences become an emotional resource on which Patient Leaders can draw to influence future service design and decision-making processes. Second, Public Narrative provides a simple and compelling structure through which Patient Leaders can enhance their skills, confidence and capability as "healthcare leaders," both individually and collectively. Conclusions The Public Narrative framework can significantly enhance the confidence, capability and skills of Patient Leaders, both to identify and coalesce around shared purpose and to advance genuine co-production in the design and improvement of healthcare services in general and maternity services in specific.
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Affiliation(s)
- Emilia Aiello
- Department of Sociology, Autonomous University of Barcelona, Cerdanyola del Vallés, Barcelona, Spain,*Correspondence: Emilia Aiello
| | - Kathryn Perera
- National Health Service (NHS) Horizons, London, United Kingdom
| | - Mo Ade
- Maternity Voices Partnership (MVP) Chair and Patient Public Voice, National Health Service, Ashford, United Kingdom
| | - Teresa Sordé-Martí
- Department of Sociology, Autonomous University of Barcelona, Cerdanyola del Vallés, Barcelona, Spain
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