Best practices in teaching/learning health advocacy in medical schools – a systematic review

1. Best practices in teaching/learning health advocacy in medical schools – a systematic review Dr Indira SamarawickremaAustralian National University A/Prof Christine Phillips Australian National University Prof Donna MakUniversity of Notre Dame

2. Introduction • Conventionally focused on individual patient care, access to care and direct socio-economic influences1. • Greater engagement in improving the health of populations and systems of care2. • Health advocate – Australia3, USA, Canada4

3. Knowledge and skills required for a generalist medical graduate • “innovative, collaborative, participatory and transformative approaches”5,6,7 • Identify, define, strategic partners, a strategic action plan, an effective message”5 • Need reasoning and communication skills4.

4. Aims and objectives • To systematically review publications on teaching/learning advocacy in medical schools • Identify best practice methods in developing skills in health advocacy among medical students.

5. Research question • What are the best practice methods in developing skills in health advocacy among medical students?

6. PICOS • Participants- medical students • Intervention: health advocacy modules with hands-on experience • Comparisons: health advocacy moduleswithout hands-on experience • Outcomes: Skills in advocacy as evident with evaluations • Study design: experimental and/or evaluation

7. Methods • We carried out a systematic review of publications • Database: PubMed, ERIC via NLM • Search terms: “advocacy” and “medic*” in the article • Time period: 1st Jan 2011 to 14 Sept 2014

8. Initial screening N=1300 Duplicates = 96 N=1204 Does not mention medical students =1173 N=31 Not in English = 3 Commentaries = 2 N=26 Does not address teaching/learning in curriculum; exclude electives N=4

9. Results • Four from medical schools in North America • Three from USA • One from Canada • None from Australia

10. Table 1: Summary of included studies

11. Table 1: Summary of included studies (contd.)

12. Table 1: Summary of included studies (contd.)

13. Table 1: Summary of included studies (contd.)

14. Discussion • In-class + hands-on modules. • Diverse experiential learning • Advocacy projects/internships with CBOs • Legislative advocacy • Evaluation of hands-on modules • Improved skills • Empowerment • Likelihood of future engagement • Self-efficacy • Rated highly by students.

15. Discussion • Small scale initiatives not integrated into the broader population health curricula. • Lacks a more robust positioning of advocacy within the curriculum.

16. AMC new medical graduate outcomes and advocacy3 • One of the four domains • Two of the first three outcome standards in that domain • How to advocate for others (not only about populations and inequality) • Knowledge, some exposure to the concepts and a public health responsibility

17. Challenges of teaching specialised skills to generalist medical graduates • How a generalistcould apply it in their normal daily practice. • Ethics of advocacy • Potential to cause harm to people and communities  • Adaptability of focused skills • No evidence that the education translated into better medical practice?

18. Limitations • Grey literature not included • Unpublished • Teaching to the interested only • Self-education

19. Conclusions • Hands-on teaching/learning activities improved skills in advocacy among medical students in North America. • More work is required to assess the breadth and effectiveness of medical school health advocacy teaching programs in Australia.

20. References • Gruen RL, Pearson SD, Brennan TA. Physician-citizens-public roles and professional obligations. JAMA. 2004 Jan 7;291(1):94-8. • FrenkJ, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376(9756):1923-58. • Medical Board of Australia. Accreditation standards for primary medical education providers and their program of study and graduate outcome statements. Canberra: Medical Board of Australia 2012. • Frank JR, editor. The CanMEDS 2005 physician competency framework. Ottawa: Office of Education, The Royal College of Physicians and Surgeons of Canada; 2005. Earnest MA, Wong SL, Federico SG. Perspective: Physician advocacy: what is it and how do we do it. Acad Med. 2010 Jan;85(1):63-7. • Earnest MA, Wong SL, Federico SG. Perspective: Physician advocacy: what is it and how do we do it. Acad Med. 2010 Jan;85(1):63-7. • Martin D, Hum S, Han M, Whitehead. Laying the foundation: teaching policy and advocacy to medical students. Med Teach. 2013 May;35:352-8. • DharamsiS, Ho A, Spadafora SM, Woolard R. The physician as health advocate: translating the quest for social responsibility in medical education and practice. Acad Med. 2011 Sep;86(9):1108-13. • Belkovitz J, SandersLM, Zhang C, Agarwal G, etal. Teaching health advocacy to medical students: a comparison study. J Public Health Manag Prac. 2013 Dec 6 (Epub ahead of print) • HuntoonKM, McCluney CJ, Wiley EA, Scannell CA, Bruno R, Stull MJ. Self-reported evaluation of competencies and attitudes by physicians-in-training before and after a single day legislative advocacy experience. BMC Med Educ. 2012 Jun 22;12-47. • Gill PJ, Gill HS. Health advocaccy training: why are physicians withholding life saving care: Med Teach. 2011;33(8):677-9. • Long JA, Lee RS, Federico S, Battaglia C, Wong S, Earnest M. Developing leadership and advocacy skills in medical students through service learning. J Public Health ManagPract. 2011 Jul-Aug: 17(4); 369-72.