Navigating the uncertainty of health advocacy teaching and evaluation from the trainee’s perspective

Abstract

Background

There may be no competency more shrouded in uncertainty than health advocacy (HA), raising questions about the robustness of advocacy training in postgraduate medical education. By understanding how programs currently train HA, we can identify whether trainees’ learning needs are being met.

Methods

From 2017 to 2019, we reviewed curricular documents across nine direct-entry specialties at all Ontario medical schools, comparing content for the HA and communicator roles to delineate role-specific challenges. We then conducted semi-structured interviews with trainees (n = 9) and faculty (n = 6) to review findings and discuss their impact. Data were analyzed using thematic content analysis.

Results

Curricular documents revealed vague objectives and ill-defined modes of assessment for both intrinsic roles. This uncertainty was perceived as more problematic for HA, in part because HA seemed both undervalued in, and disconnected from, clinical learning. Trainees felt that the onus was on them to figure out how to develop and demonstrate HA competence, causing many to turn their learning attention elsewhere.

Discussion

Lack of curricular focus seems to create the perception that advocacy isn’t valuable, deterring trainees—even those keen to become competent advocates—from developing HA skills. Such ambivalence may have troubling downstream effects for both patient care and trainees’ professional development.

Keywords:

• Health advocate
• advocacy
• competency-based medical education
• managing uncertainty in medical education
• communicator

Acknowledgments

The authors wish to thank the participants for sharing their experiences.

Ethical approval

This study received ethical approval from the Ottawa Health Science Network Research Ethics Board (Protocol# 20180472-01H).

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

Health Advocacy: Although it is variably understood, health advocacy is defined by the Royal College of Physicians and Surgeons of Canada as those who contribute their expertise and influence as they work with communities or patient populations to improve health. They work with those they serve to determine and understand needs, speak on behalf of others when required, and support the mobilization of resources to effect change.

Additional information

Funding

This research was funded by a grant from the Medical Education Research/Innovation Project Fund, Department of Medicine, University of Ottawa.

Notes on contributors

Kaitlin Endres

Ms. Kaitlin Endres BSc, is a fourth-year medical student with an interest in health advocacy and medical education. She was awarded the Children’s Hospital of Eastern Ontario Research Institute Dr. James Wiley Endowment Fund for her contribution to healthcare research. Contributions included study design, interview data collection, thematic coding and analysis and manuscript preparation.

Sarah Burm

Dr. Sarah Burm is a PhD-trained education specialist and Assistant Professor in the Department of Medicine at Dalhousie University with passions for medical education, social justice and equity. Contributions included co-supervisor of study, study conception and design, content expert, coding and analysis of qualitative data, manuscript preparation and editing.

Daniel Weiman

Mr. Daniel Weiman, BSc, is a fourth-year medical student with a passion for health advocacy and pediatric medicine. He serves as the University of Ottawa’s Student Representative and Leader for Choosing Wisely Canada. Contributions included interview data collection, coding and analysis of qualitative data, as well as manuscript writing.

Dalia Karol

Dr. Dalia Karol is a first-year trainee in Obstetrics and Gynecology at the University of Toronto. She received the Federation of Medical Women of Canada Student Leadership Award for her contributions in advancing research on managing women with bleeding disorders. Contributions included coding and analysis of qualitative data, as well as manuscript writing.

Nancy Dudek

Dr. Nancy Dudek is an Assistant Professor and Physiatrists with strong interests in advocacy and medical education. She holds a MSc in Education and is a previous recipient of the Dr. Meridith Marks Educator Award for Innovation and Scholarship in Medical Education. Contributions included concept and study design and manuscript editing.

Lindsay Cowley

Ms. Lindsay Cowley is a MA-trained research and project assistant at the Department of Innovation in Medical Education at the University of Ottawa. Contributions included study and concept design, literature review and manuscript editing.

Kori LaDonna

Dr. Kori LaDonna is a PhD-trained education specialist and Assistant Professor in the University of Ottawa Department of Medicine with a strong interest in trainee wellness and health advocacy. Contributions included serving as primary project supervisor, study conception and design, content expert, coding and analysis of qualitative data, manuscript preparation and editing.