Fundamental components of a curriculum for residents in health advocacy

Figures & data

Table

Practice points
The role of Health Advocate speaks to social accountability. Health Advocacy can be defined by six attributes. These attributes can be characterized by desirable and undesirable behaviours. Health Advocate can be taught in a graded fashion from individual to society. Evaluation of Health Advocate can be measured by observable behaviours.

Table 1.  Attributes of health advocate identified by expert panel

Knowledgeable

Altruistic

Honest

Assertive

Resourceful

Up-to-date

Figure 1. Progression of training and the scope of health advocate. Figure 1(a) demonstrates the inseparable relationship between advocating for the individual, community, and society. Figure 1(b) demonstrates a curriculum framework for teaching the Health Advocate. The model incorporates the graded teaching of advocacy skills in parallel with the progressive training of the scope of health advocate. Content examples are given at appropriate training levels. The double arrow lines are meant to reflect that some residents will have varied life experiences and a ‘sliding scale’ is needed to account for these.

Figure 2. Schematic model of the Determinants of Health emphasizing that education is the most important determinant and influences all of the other determinants (arrows). Social environments is broken into multiple components e.g. social support network and income and social status.

Table 2.  Matching the attributes of health advocate with the CanMEDs roles

Attribute	CanMEDS role
Knowledgeable	Expert
Altruistic	Professional
Honest	Communicator
Assertive	Collaborator
Resourceful	Manager
Up-to-date	Scholar

Table 3.  Attribute desirable and undesirable behaviours and their evaluation

Attribute	Desirable Behaviour	Undesirable	Teaching method	Evaluation
Knowledgeable	Supports information Applies knowledge Disseminates Knows limitations	Fails to share Inaccurate	Clinical moment Role model Dossier	OSCE Review dossier
Altruistic	Demonstrates concern of welfare of others Steps out beyond expected Listens to needs	Martyrdom Procrastination	Role modeling Story telling	Clinical observation
Honest	Sensitivity, discloses errors Communicates about difficult issues Balances life Realistic expectations	Insensitive Fearful to discuss difficult issues Unfulfilled promises Defensive communicator	Role model, case discussion, standardized patients videotapes	Case audits, bedside Evaluation, Standardized patients Videotapes
Assertive	Confidence, initiative to solve problems, consults allied professionals, notifies GP of discharge, prescription, refers to CCAC	Passiveness Lacks sensitivity Aggressiveness Bullying	Role modeling, clinical moment Case review	Case Review Case Presentation
Resourceful	Priority setting Flexibility and Resourceful Perseverance Co-operative Knowledgeable about system	Rigidity Poor relationship with other disciplines Dismissive of team members	Cases Small groups Lectures Standardized patients	Performance on ward and clinic Problem simulation Case record audits Chart review OSCE
Up-to-date	Activities (e.g. rounds, conferences, journal clubs) Disseminates information Reflects on role of health advocate in above activities	Stagnates	Didactic, PBL, Role modeling, Journal club	MCQ,OSCE, Case Formulation, Oralv Presentation, Clinical observation

Note: OSCE = Office Simulated Clinical Exam; CCAC = Community Care Access Center; MCQ = Multiple Choice Question; PBL = Problem Based Learning.

Figure 3. Proposed pyramid model of the CanMEDS role reflecting the complexity and diverse skill set needed to be a successful health advocate. To develop as a heath advocate, students must acquire the multiple skill sets required of a physician in an incremental fashion.