A is for advocacy: How introducing student advocacy assessment impacts longitudinal integrated clerkship students and clinical supervisors

Abstract

To improve health, physicians are increasingly called to advocate. Yet medical schools have only recently focused on health advocacy skill-building. Limited work to date addresses assessing medical student advocacy on behalf of patients. We describe how students and clinical supervisors (CS) in two urban longitudinal integrated clerkships (LIC) experience patient advocacy and how introducing a new advocacy assessment impacts them. Using a thematic approach, we analyzed transcripts of focus groups during 2018–2019. Seventeen of 24 (71%) students and 15 of 21 (71%) CS participated in the focus groups. We describe how students perceive their advocacy role as they accompany the patient, amplify their voice, and facilitate connection. The rationale for advocacy assessment includes that it (1) adds a novel dimension to the written and verbal assessment, (2) drives student learning, (3) aligns with the institutional goal to promote equity, and (4) impacts CS teaching and clinical practice. Challenges are the ambiguity of expectations, pressure to ‘perform,’ and a moral overlay to advocacy assessment. Findings demonstrate how educational alliances between students and CS and longitudinal relationships between LIC students and patients offer a constructive opportunity for advocacy assessment. We describe suggestions to hone and expand the reach of advocacy assessment.

Keywords:

• Clinical assessment
• professionalism (learning outcomes)
• undergraduate (phase of education)
• medicine
• clinical teaching and learning

Glossary

Longitudinal integrated clerkship: A longitudinal integrated clerkship is characterized by being the central element of clinical education whereby medical students (1) participate in the comprehensive care of patients over time, (2) participate in continuing learning relationships with these patients’ clinicians, and (3) meet the majority of the year’s core clinical competencies, across multiple disciplines simultaneously, through these experiences (Norris et al. 2009).

Acknowledgments

We would like to thank Drs. Gurpreet Dhaliwal, Margaret Wheeler, Andrea Jackson, Bridget O’Brien, Patricia O’Sullivan, Nardine Riegels, and Lindsay Mazotti for their advice and guidance, Quincy Mccrary for his assistance in manuscript preparation, and the Center for Faculty Educators ESCape scholarship consultation group for their feedback on our project.

Disclosure statement

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

Additional information

Notes on contributors

Tali Ziv

Dr. Tali Ziv, MD, an internist at Kaiser Permanente and associate professor at the University of California, San Francisco School of Medicine (UCSF), directs Kaiser Permanente East Bay – UCSF Longitudinal Integrated Clerkship (KLIC EB). She focuses on LIC workplace learning innovation and coaches LIC learners and faculty in professional development.

Maria Wamsley

Dr. Maria Wamsley, MD, is a practicing internist and professor at the University of California San Francisco School of Medicine (UCSF). She co-directs the UCSF PISCES Longitudinal Integrated Clerkship and is the Director for the UCSF Program for Interprofessional Practice and Education.

Cindy J. Lai

Dr. Cindy J. Lai, MD, is a professor of medicine at the University of California, San Francisco School of Medicine (UCSF). She directs the medical students’ clinical rotations for the Department of Medicine. She is focused on creating initiatives to optimize the clinical learning environment.

Elizabeth P. Griffiths

Dr. Elizabeth P. Griffiths, MD, MPH, is a general internist and assistant professor at the University of California San Francisco School of Medicine (UCSF). She teaches and directs courses in health policy, advocacy, and community engagement to medical students, residents, and faculty.

Alexandra Maxey

Alexandra Maxey, BA, is a medical student at the University of California, San Francisco (UCSF) and is a member of the Program in Medical Education for the Urban Underserved (PRIME-US). She is passionate about patient advocacy, healthcare disparities, and building awareness about these important topics in medical education. Her work was supported by a UCSF Summer Student Fellowship.

Irina (Era) Kryzhanovskaya

Dr. Irina (Era) Kryzhanovskaya, MD, is a general internist and assistant professor at the University of California San Francisco (UCSF). She is Internal Medicine Liaison for the UCSF PISCES Longitudinal Integrated Clerkship. She directs and teaches courses on communication, wellness, and addiction medicine for students, residents, interprofessional colleagues, and faculty.

Arianne Teherani

Arianne Teherani, PhD, is a professor of medicine and education scientist, Center for Faculty Educators, School of Medicine, University of California, San Francisco. Arianne has led studies on the identification and remediation of unprofessional behaviors and the role of assessment and learning environment practices which perpetuate disparities and interventions aimed at creating equity.