The time has come to reassess how advocacy is taught to medical students, say Zachary Smothers and Delbert Wigfall

Advocacy skills are a core tenet of medicine and should be incorporated into the medical curriculum. Medical schools must ensure that students are adequately trained in advocating for patient’s rights, especially as these very rights are being threatened. The current climate is putting a squeeze on the medical curriculum, with non-clinical skills being pushed out in favour of more clinical teaching. At a time when demand for advocacy skills is high and growing, the opportunities to develop these skills in medical schools is waning.

Advocacy may take many forms, it occurs at multiple levels of engagement (individual, local, national), and can come from any health provider, not just physicians. However, the advocacy we are referring to is on the personal level—specifically, a single doctor-patient encounter. While all forms and levels of advocacy are valuable, the intimate connection that comes with personal advocacy is being lost in medicine, especially at the undergraduate medical level.

The time has come for a reassessment of the way advocacy is taught to medical students. We are given opportunities every day to advocate for our patients and positively affect the way the healthcare system interacts with the public. These opportunities must be seized upon if we hope to change the landscape of widespread disparities. However, the current medical curriculum does not provide students with the training that they need to identify potential advocacy situations and to engage with patients in a meaningful way.

To begin, medical schools need to make a focused effort on training students to identify potential advocacy situations. Much of medical education is being shifted to case based learning, with students being trained to identify disease presentations. This type of case based educational system provides excellent opportunities to allow students to not only learn disease presentations, but advocacy scenarios. One potential avenue for teaching students how to advocate would be to discuss common disparities seen in their local health system, and identify how advocacy can be used to address these disparities.

Medical schools can start by discussing common disparities in their areas with practising physicians and working these disparities into their case discussion. This would require their students to not only identify the disease and treatment, but also the ways they could intervene to advocate for their patient. An example of this would be a medical school in the United States identifying the impact that a language barrier could have on patient autonomy. This situation could be used to inform students of local resources that provide services in the patient’s specific language.

Allowing medical students to engage with the idea of advocacy in this way would normalise the concept of the physician as an advocate. By working advocacy into their learning, students will become adept at identifying situations in which they can engage with their patients, help them access appropriate healthcare, and provide a protected environment for improvement. Additionally, if the disparities presented are based on the local community, students may become more aware of local resources that they can use to assist their patient.

Medical schools should also include advocacy as a required competency for their clinical clerkships. Many medical schools may include some ideas and training on advocacy as part of their pre-clinical education, but these lessons are lost if they are not reinforced during the clinical year. Schools should identify and motivate individuals who are able to teach medical students about advocacy, and include them in student’s learning. These “advocacy mentors” should be a diverse set of individuals with unique experiences, such as physicians, nurses, peer advocates, social workers, and pharmacists. These mentors should provide feedback to students who miss a potential advocacy scenario, or who attempt advocacy but need additional guidance.

Finally, medical schools can increase student’s advocacy skills by requiring them to engage with the medical system outside of their normal role. One example of this would be asking students to “mock” enrol in disability benefits without the aid of any outside resource. Seeing the long process and complicated paperwork required to file for, prove, and receive disability benefits would provide students an inside look into how some of the disparities in medicine manifest themselves. This could also serve as a training tool for students to learn about the processes they may be asked by their patients to participate in.

Giving students these types of experiences provides a realistic picture of the current medical landscape and an opportunity to gain a complete view of what interacting with the medical system is like for the majority of Americans.

The medical system is rapidly changing and medical schools are struggling to keep up with the pace. This accelerated change and emphasis on science has not addressed the rampant disparities seen in the health system. Advocacy has been lost in the medical curriculum and students are not being adequately trained as advocates. We believe that building advocacy into the medical curriculum can address some of these disparities and create physicians who are capable of treating a diverse population with many different experiences.

 

Zachary Paul Wargo Smothers is a medical student at Duke University School of Medicine.

Competing interests: None declared.

 

 

Delbert Raye Wigfall is associate dean for medical education, professor of paediatrics, Duke University School of Medicine

Competing interests: None declared.

 

References:

1. U.S. Census Bureau. Income And Poverty in the United States. 2014. Washington, D.C.: U.S. Government Printing Office; 2015 p. 60-252.
2. The Henry J. Kaiser Family Foundation. Key Facts on Health and Healthcare By Race and Ethnicity [Internet]. Menlo, CA: Kaiser Family Foundation; 2016. Available from: http://files.kff.org/attachment/Chartpack-Key-Facts-on-Health-and-Health-Care-by-Race-and-Ethnicity
3. The Henry J. Kaiser Family Foundation. Health and Access to Care And Coverage for Lesbian, Gay, Bisexual, And Transgender (LGBT) Individuals In The U.S.[Internet]. Menlo, CA: Kaiser Family Foundation; 2018. Available from: https://www.kff.org/disparities-policy/issue-brief/health-and-access-to-care-and-coverage-for-lesbian-gay-bisexual-and-transgender-individuals-in-the-u-s/. Accessed 9 July 2018.
4. Dzau V, Cho A, ElLaissi W, Yoediono Z, Sangvai D, Shah B et al. Transforming Academic Health Centers for an Uncertain Future. New England Journal of Medicine. 2013;369(11):991-993.