Conceptualization and teaching health advocacy in undergraduate medical education: a document analysis.
Competency-based medical education
Document analysis
Health advocacy
Social responsibility of physicians
Undergraduate medical education
Journal
BMC medical education
ISSN: 1472-6920
Titre abrégé: BMC Med Educ
Pays: England
ID NLM: 101088679
Informations de publication
Date de publication:
28 Sep 2024
28 Sep 2024
Historique:
received:
22
12
2023
accepted:
17
09
2024
medline:
29
9
2024
pubmed:
29
9
2024
entrez:
28
9
2024
Statut:
epublish
Résumé
Health advocacy is considered to be a core competence for physicians, but it remains unclear how the health advocacy role, despite being described in overarching competency frameworks, is operationalized in undergraduate medical education (UME). This study aimed to identify how health advocacy is conceptualized and taught in undergraduate medical curricula. We performed a qualitative analysis of curriculum documents from all eight medical schools in the Netherlands, all of which offered competency-based UME. Thematic analysis was used to code all the documents and generate themes on health advocacy conceptualization and teaching. To categorize the emerging themes, we used the framework of Van Melle et al. for evaluating the implementation of competency-based medical educational programs. Health advocacy was mostly conceptualized in mission statements about social responsibility of future physicians, related to prevention and promoting health. We found key concepts of health advocacy to be taught mainly in public health and social medicine courses in the bachelor stage and in community-based clerkships in the master stage. Specific knowledge, skills and attitudes related to health advocacy were taught mostly in distinct longitudinal learning pathways in three curricula. Health advocacy is conceptualized mostly as related to social responsibility for future physicians. Its teaching is mostly embedded in public health and social medicine courses and community-based settings. A wider implementation is warranted, extending its teaching to the full width of medical teaching, with longitudinal learning pathways providing a promising route for more integrative health advocacy teaching.
Sections du résumé
BACKGROUND
BACKGROUND
Health advocacy is considered to be a core competence for physicians, but it remains unclear how the health advocacy role, despite being described in overarching competency frameworks, is operationalized in undergraduate medical education (UME). This study aimed to identify how health advocacy is conceptualized and taught in undergraduate medical curricula.
METHODS
METHODS
We performed a qualitative analysis of curriculum documents from all eight medical schools in the Netherlands, all of which offered competency-based UME. Thematic analysis was used to code all the documents and generate themes on health advocacy conceptualization and teaching. To categorize the emerging themes, we used the framework of Van Melle et al. for evaluating the implementation of competency-based medical educational programs.
RESULTS
RESULTS
Health advocacy was mostly conceptualized in mission statements about social responsibility of future physicians, related to prevention and promoting health. We found key concepts of health advocacy to be taught mainly in public health and social medicine courses in the bachelor stage and in community-based clerkships in the master stage. Specific knowledge, skills and attitudes related to health advocacy were taught mostly in distinct longitudinal learning pathways in three curricula.
CONCLUSION
CONCLUSIONS
Health advocacy is conceptualized mostly as related to social responsibility for future physicians. Its teaching is mostly embedded in public health and social medicine courses and community-based settings. A wider implementation is warranted, extending its teaching to the full width of medical teaching, with longitudinal learning pathways providing a promising route for more integrative health advocacy teaching.
Identifiants
pubmed: 39342200
doi: 10.1186/s12909-024-06039-0
pii: 10.1186/s12909-024-06039-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1064Informations de copyright
© 2024. The Author(s).
Références
Frank JR, Schnell L, Sherbino J. CanMeds 2015 Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015.
Trilk JL, Muscato D, Polak R. Advancing lifestyle medicine education in undergraduate medical school curricula through the lifestyle medicine education collaborative. Am J Lifestyle Med. 2016;12(5):412–8. https://doi.org/10.1177/1559827616682475 .
doi: 10.1177/1559827616682475
Mackenbach JP. Politics is nothing but medicine at a larger scale: reflections on public health’s biggest idea. J Epidemiol Community Health. 2009;63(3):181–4. https://doi.org/10.1136/jech.2008.077032 .
doi: 10.1136/jech.2008.077032
Earnest MA, Wong SL, Federico SG, Perspective. Physician advocacy: what is it and how do we do it? Acad Med. 2010;85(1):63–7. https://doi.org/10.1097/ACM.0b013e3181c40d40 .
doi: 10.1097/ACM.0b013e3181c40d40
Hubinette M, Dobson S, Scott I, Sherbino J. Health advocacy. Med Teach. 2017;39(2):128–35. https://doi.org/10.1080/0142159X.2017.1245853 .
doi: 10.1080/0142159X.2017.1245853
Swing SR. The ACGME outcome project: retrospective and prospective. Med Teach. 2007;29(7):648–54. https://doi.org/10.1080/01421590701392903 .
doi: 10.1080/01421590701392903
General Medical Council. Tomorrow’s Doctors: Outcomes and Standards for Undergraduate Medical Education. United Kingdom: General Medical Council. 2009. http://www.gmc-uk.org/static/documents
Frank JR, Snell LS, Cate OT, Holmboe ES, Carraccio C, Swing SR, Harris P, Glasgow NJ, Campbell C, Dath D, Harden RM, Iobst W, Long DM, Mungroo R, Richardson DL, Sherbino J, Silver I, Taber S, Talbot M, Harris KA. Competency-based medical education: theory to practice. Med Teach. 2010;32(8):638–45. https://doi.org/10.3109/0142159X.2010.501190 .
doi: 10.3109/0142159X.2010.501190
Boroumand S, Stein MJ, Jay M, Shen JW, Hirsh M, Dharamsi S. Addressing the health advocate role in medical education. BMC Med Educ. 2020;20(1):28. https://doi.org/10.1186/s12909-020-1938-7 .
doi: 10.1186/s12909-020-1938-7
Dobson S, Voyer S, Hubinette M, Regehr G. From the clinic to the community: the activities and abilities of effective health advocates. Acad Med. 2015;90(2):214–20. https://doi.org/10.1097/ACM.0000000000000588 .
doi: 10.1097/ACM.0000000000000588
Poulton A, Rose H. The importance of health advocacy in Canadian postgraduate medical education: current attitudes and issues. Can Med Educ J. 2015;6(2):e54–60.
doi: 10.36834/cmej.36665
McDonald M, Lavelle C, Wen M, Sherbino J, Hulme J. The state of health advocacy training in postgraduate medical education: a scoping review. Med Educ. 2019;53(12):1209–20. https://doi.org/10.1111/medu.13929 .
doi: 10.1111/medu.13929
Griewatz J, Yousef A, Rothdiener M, Lammerding-Koeppel M, Collaborators of the MERlin Mapping Group. Are we preparing for collaboration, advocacy and leadership? Targeted multi-site analysis of collaborative intrinsic roles implementation in medical undergraduate curricula. BMC Med Educ. 2020;20(1):35. https://doi.org/10.1186/s12909-020-1940-0 .
doi: 10.1186/s12909-020-1940-0
Stutsky BJ, Singer M, Renaud R. Determining the weighting and relative importance of CanMEDS roles and competencies. BMC Res Notes. 2012;5:354. https://doi.org/10.1186/1756-0500-5-354 .
doi: 10.1186/1756-0500-5-354
Rademakers JJ, de Rooy N, Ten Cate OT. Senior medical students’ appraisal of CanMEDS competencies. Med Educ. 2007;41(10):990–4. https://doi.org/10.1111/j.1365-2923.2007.02842.x .
doi: 10.1111/j.1365-2923.2007.02842.x
Girard VW, Moore ES, Kessler LP, Perry D, Cannon Y. An Interprofessional Approach to Teaching Advocacy skills: lessons from an Academic Medical-Legal Partnership. J Leg Med. 2020 Apr-Jun;40(2):265–78. https://doi.org/10.1080/01947648.2020.1819485 .
doi: 10.1080/01947648.2020.1819485
Croft D, Jay SJ, Meslin EM, Gaffney MM, Odell JD. Perspective: is it time for advocacy training in medical education? Acad Med. 2012;87(9):1165–70. https://doi.org/10.1097/ACM.0b013e31826232bc .
doi: 10.1097/ACM.0b013e31826232bc
Kline CC, Park SE, Godolphin WJ, Towle A. Professional identity formation: a role for patients as mentors. Acad Med. 2020;95(10):1578–86. https://doi.org/10.1097/ACM.0000000000003561 .
doi: 10.1097/ACM.0000000000003561
Flynn L, Verma S. Fundamental components of a curriculum for residents in health advocacy. Med Teach. 2008;30(7):e178–83. https://doi.org/10.1080/01421590802139757 .
doi: 10.1080/01421590802139757
Griffiths EP, Lai CJ, Ziv T, Dawson D, Dhaliwal G, Wheeler M, Teherani A. Patient Advocacy Assessment in the Medicine Clerkship: a qualitative study of definition, Context, and impact. J Gen Intern Med. 2022;37(10):2489–95. https://doi.org/10.1007/s11606-021-07359-3 .
doi: 10.1007/s11606-021-07359-3
Sood M, Blane DN, Williamson AE. A drive to make change’ - exploring the views and experiences of medical students engaging in advocacy: a qualitative study in a UK medical school. Educ Prim Care. 2023;34(1):44–6. https://doi.org/10.1080/14739879.2022.2161071 .
doi: 10.1080/14739879.2022.2161071
Scott MD, McQueen S, Richardson L. Teaching Health Advocacy: a systematic review of Educational interventions for Postgraduate Medical trainees. Acad Med. 2020;95(4):644–56. https://doi.org/10.1097/ACM.0000000000003063 .
doi: 10.1097/ACM.0000000000003063
Prideaux D, Curriculum design. BMJ. 2003;326(7383):268–70. https://doi.org/10.1136/bmj.326.7383.268 .
doi: 10.1136/bmj.326.7383.268
Raamplan: Medical Training Framework 2020: The Netherlands Federation of University Medical Centres. https://www.nfu.nl/sites/default/files/2020-08/20.1577_Raamplan_Medical_Training_Framework_2020_-_May_2020.pdf . (nfu.nl).
Bowen GA. Document analysis as a qualitative research method. QualRes J. 2009 Vol;9(2):27–40. https://doi.org/10.3316/QRJ0902027 .
doi: 10.3316/QRJ0902027
Van Melle E, Frank JR, Holmboe ES, Dagnone D, Stockley D, Sherbino J. International Competency-based Medical Education Collaborators. A Core Components Framework for evaluating implementation of competency-based Medical Education Programs. Acad Med. 2019;94(7):1002–9. https://doi.org/10.1097/ACM.0000000000002743 .
doi: 10.1097/ACM.0000000000002743
Dharamsi S, Ho A, Spadafora SM, Woollard R. The physician as health advocate: translating the quest for social responsibility into medical education and practice. Acad Med. 2011;86(9):1108–13. https://doi.org/10.1097/ACM.0b013e318226b43b .
doi: 10.1097/ACM.0b013e318226b43b
Schneider AR, Sharma T, Bhattacharya A, Brown A. Exploring the relationship between social accountability and competency-based medical education: a narrative review. Med Teach. 2022;44(11):1283–9. https://doi.org/10.1080/0142159X.2022.2093702 .
doi: 10.1080/0142159X.2022.2093702
Castillo EG, Isom J, DeBonis KL, Jordan A, Braslow JT, Rohrbaugh R. Reconsidering systems-based practice: advancing structural competency, Health Equity, and social responsibility in Graduate Medical Education. Acad Med. 2020;95(12):1817–22. https://doi.org/10.1097/ACM.0000000000003559 .
doi: 10.1097/ACM.0000000000003559
Boelen C, Heck JE, WHO. Defining and measuring the social accountability of medical schools. Geneva: World Health Organization; 1995. https://apps.who.int/iris/bitstream/handle/10665/59441/WHO_HRH_95.7.pdf?sequence=1 .
Boelen C, Dharamsi S, Gibbs T. The social accountability of medical schools and its indicators. Educ Health (Abingdon). 2012;25(3):180–94. https://doi.org/10.4103/1357-6283.109785 .
doi: 10.4103/1357-6283.109785
Douglas A, Mak D, Bulsara C, Macey D, Samarawickrema I. The teaching and learning of health advocacy in an Australian medical school. Int J Med Educ. 2018;9:26–34. https://doi.org/10.5116/ijme.5a4b.6a15 .
doi: 10.5116/ijme.5a4b.6a15
Shankar S, Phinney R, Krapek A, Surapaneni VL. Building a Community-Centered Public Health Advocacy Training Program for Medical Students. J Public Health Manag Pract 2022 Jul-Aug 01;28(4):E692–701. https://doi.org/10.1097/PHH.0000000000001486
doi: 10.1097/PHH.0000000000001486
Vyas A, Rodrigues VC, Ayres R, Myles PR, Hothersall EJ, Thomas H. Public health matters: innovative approaches for engaging medical students. Med Teach. 2017;39(4):402–8. https://doi.org/10.1080/0142159X.2017.1294753 .
doi: 10.1080/0142159X.2017.1294753
Bhate TD, Loh LC. Building a generation of physician advocates: the case for including mandatory training in Advocacy in Canadian Medical School Curricula. Acad Med. 2015;90(12):1602–6. https://doi.org/10.1097/ACM.0000000000000841 .
doi: 10.1097/ACM.0000000000000841
Goyal RK, Dawson CA, Epstein SB, Brach RJ, Finnie SM, Lounsbury KM, Lahey T, Eldakar-Hein ST. The design and implementation of a longitudinal social medicine curriculum at the University of Vermont’s Larner College of Medicine. BMC Med Educ. 2021;21(1):131. https://doi.org/10.1186/s12909-021-02533-x . Erratum in: BMC Med Educ. 2021;21(1):154.
doi: 10.1186/s12909-021-02533-x
Gonzalo JD, Haidet P, Papp KK, Wolpaw DR, Moser E, Wittenstein RD, Wolpaw T. Educating for the 21st-Century Health Care System: an interdependent Framework of Basic, Clinical, and Systems sciences. Acad Med. 2017;92(1):35–9. https://doi.org/10.1097/ACM.0000000000000951 .
doi: 10.1097/ACM.0000000000000951
Lucey CR. Medical education: part of the problem and part of the solution. JAMA Intern Med. 2013;173(17):1639–43. https://doi.org/10.1001/jamainternmed.2013.9074 .
doi: 10.1001/jamainternmed.2013.9074
Doobay-Persaud A, Adler MD, Bartell TR, Sheneman NE, Martinez MD, Mangold KA, Smith P, Sheehan KM. Teaching the Social Determinants of Health in Undergraduate Medical Education: a scoping review. J Gen Intern Med. 2019;34(5):720–30. https://doi.org/10.1007/s11606-019-04876-0 .
doi: 10.1007/s11606-019-04876-0
Fung OW, Ying Y. Twelve tips to center social accountability in undergraduate medical education. Med Teach. 2022;44(11):1214–20. https://doi.org/10.1080/0142159X.2021.1948983 .
doi: 10.1080/0142159X.2021.1948983
Mihan A, Muldoon L, Leider H, Tehfe H, Fitzgerald M, Fournier K, Kendall CE. Social accountability in undergraduate medical education: A narrative review. Educ Health (Abingdon). 2022;35(1):3–8. https://doi.org/10.4103/efh.efh_305_21 .
doi: 10.4103/efh.efh_305_21
Brender TD, Plinke W, Arora VM, Zhu JM. Prevalence and characteristics of Advocacy Curricula in U.S. Medical Schools. Acad Med. 2021;96(11):1586–91. 10.1097.
doi: 10.1097/ACM.0000000000004173
Bhatti AJ, Lin S, Post D, Baldock K, Dawes N. Prevalence and characteristics of advocacy curricula in Australian public health degrees. Health Promot J Austr. 2022;33(1):50–6. https://doi.org/10.1002/hpja.634 .
doi: 10.1002/hpja.634
Colest CR, Grants JG. Curriculum evaluation in medical and health-care education. Med Educ. 1985;19:405–22.
doi: 10.1111/j.1365-2923.1985.tb01345.x