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How Are We Teaching Advocacy? A National Survey of Internal Medicine Residency Program Directors

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Abstract

Background

Although internal medicine (IM) physicians accept public advocacy as a professional responsibility, there is little evidence that IM training programs teach advocacy skills. The prevalence and characteristics of public advocacy curricula in US IM residency programs are unknown.

Objectives

To describe the prevalence and characteristics of curricula in US IM residencies addressing public advocacy for communities and populations; to describe barriers to the provision of such curricula.

Design

Nationally representative, web-based, cross-sectional survey of IM residency program directors with membership in an academic professional association.

Participants

A total of 276 IM residency program directors (61%) responded between August and December 2022.

Main Measurements

Percentage of US IM residency programs that teach advocacy curricula; characteristics of advocacy curricula; perceptions of barriers to teaching advocacy.

Key Results

More than half of respondents reported that their programs offer no advocacy curricula (148/276, 53.6%). Ninety-five programs (95/276, 34.4%) reported required advocacy curricula; 33 programs (33/276, 12%) provided curricula as elective only. The content, structure, and teaching methods of advocacy curricula in IM programs were heterogeneous; experiential learning in required curricula was low (23/95, 24.2%) compared to that in elective curricula (51/65, 78.5%). The most highly reported barriers to implementing or improving upon advocacy curricula (multiple responses allowed) were lack of faculty expertise in advocacy (200/276, 72%), inadequate faculty time (190/276, 69%), and limited curricular flexibility (148/276, 54%).

Conclusion

Over half of US IM residency programs offer no formal training in public advocacy skills and many reported lack of faculty expertise in public advocacy as a barrier. These findings suggest many IM residents are not taught how to advocate for communities and populations. Further, less than one-quarter of required curricula in public advocacy involves experiential learning.

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Data Availability

The data that informed this research survey study include a limited number of U.S. internal medicine residency program characteristics that were obtained through a data sharing license granted to the study personnel or through databases that are publicly available for querying but are not the property of the study personnel. As per the license or usage terms designated by the parties that maintain ownership of those data, the study personnel may not transfer or publish datasets that contain that information (identified or de-identified), which is intended for descriptive or comparative analyses of the survey data collected by the study personnel but may not be transferred beyond those personnel.

References

  1. ABIM Foundation; ACP-ASIM Foundation; European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243-6.

    Article  Google Scholar 

  2. Sulmasy LS, Bledsoe TA; ACP Ethics, Professionalism and Human Rights Committee. American College of Physicians Ethics Manual: Seventh Edition. Ann Intern Med. 2019;170(12 Suppl 2):S1-S32. https://doi.org/10.7326/M18-2160.

  3. American Medical Association. Declaration of professional responsibility: medicine’s social contract with humanity. Available at: https://www.ama-assn.org/system/files/2020-03/declaration-professional-responsibility-english.pdf. Accessed 24 September 2023.

  4. Gruen RL, Campbell EG, Blumenthal D. Public roles of US physicians: community participation, political involvement, and collective advocacy. JAMA. 2006;296(20):2467-75.

    Article  CAS  PubMed  Google Scholar 

  5. Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Internal Medicine 2023. Available at: https://www.acgme.org/globalassets/pfassets/programrequirements/140_internalmedicine_2023.pdf. Accessed 20 August 2023.

  6. Krishnamurthy S, Soltany KA, Montez K. Incorporating Health Policy and Advocacy Curricula Into Undergraduate Medical Education in the United States. J Med Educ Curric Dev. 2023;10:23821205231191601.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Brender TD, Plinke W, Arora VM, Zhu JM. Prevalence and characteristics of advocacy curricula in U.S. medical schools. Acad Med. 2021;96(11):1586-1591.

    Article  PubMed  Google Scholar 

  8. Accreditation Council for Graduate Medical Education. Common program requirements (residency). Available at: https://www.acgme.org/globalassets/pfassets/programrequirements/cprresidency_2023.pdf. Accessed 20 August 2023.

  9. Howell BA, Kristal RB, Whitmire LR, Gentry M, Rabin TL, Rosenbaum J. A systematic review of advocacy curricula in graduate medical education. J Gen Intern Med. 2019;34(11):2592-2601.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Agrawal N, Lucier J, Ogawa R, Arons A. Advocacy curricula in graduate medical education: an updated systematic review from 2017 to 2022. J Gen Intern Med. 2023;38(12):2792-2807.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Scott MD, McQueen S, Richardson L. Teaching health advocacy: a systematic review of educational interventions for postgraduate medical trainees. Acad Med. 2020;95(4):644-656.

    Article  PubMed  Google Scholar 

  12. Coutinho AJ, Nguyen BM, Kelly C, et al. Formal advocacy curricula in family medicine residencies: a CERA survey of program directors. Fam Med. 2020;52(4):255-261.

    Article  PubMed  Google Scholar 

  13. Vance MC, Kennedy KG. Developing an advocacy curriculum: lessons learned from a national survey of psychiatric residency programs. Acad Psychiatry. 2020;44(3):283-288.

    Article  PubMed  Google Scholar 

  14. Lichtenstein C, Hoffman BD, Moon RY. How do US pediatric residency programs teach and evaluate community pediatrics and advocacy training? Acad Pediatr. 2017;17(5):544-549.

    Article  PubMed  Google Scholar 

  15. Earnest MA, Wong SL, Federico SG. Perspective: physician advocacy: what is it and how do we do it? Acad Med. 2010;85(1):63–7.

    Article  PubMed  Google Scholar 

  16. U.S. Census Bureau. Census Regions and Divisions of the United States. Available at: https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf. Accessed on 19 December 2022.

  17. Accreditation Council for Graduate Medical Education. Accreditation Database System Online (Public). Available at: https://apps.acgme.org/ads/Public/Programs/Search. Accessed on 1 June 2022.

  18. American Medical Association. Fellowship and Residency Electronic Interactive Database Access System (FREIDA) Online. Obtained through a data license provided by the American Medical Association to the Alliance for Academic Internal Medicine. Available at: https://freida.ama-assn.org/search/list?spec=42771. License processed on 1 October 2022.

  19. American Board of Internal Medicine (ABIM). Residency Program Pass Rates [2010–2021]. Provided in June 2022 courtesy of the American Board of Internal Medicine. Available at: https://www.abim.org/Media/lhgmdidp/residency-program-pass-rates.pdf. Received on 30 June 2022.

  20. Fried JE, Shipman SA, Sessums LL. Advocacy: Achieving Physician Competency. J Gen Intern Med. 2019;34(11):2297-2298. https://doi.org/10.1007/s11606-019-05278-y.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Pediatrics 2022. Available at: https://www.acgme.org/globalassets/pfassets/programrequirements/320_pediatrics_2022.pdf. Accessed 24 September 2023.

  22. Hoffman B, Rose J, Best D, et al. The Community Pediatrics Training Initiative Project Planning Tool: A Practical Approach to Community-Based Advocacy. MedEdPORTAL. Available at: https://www.mededportal.org/publication/10630/. Accessed on 24 September 2023.

  23. Kaczorowski J. Pediatrics in the community: community pediatrics training initiative (CPTI). Pediatr Rev. 2008;29(1):31-2.

    Article  PubMed  Google Scholar 

  24. McDonald M, Lavelle C, Wen M, Sherbino J, Hulme J. The state of health advocacy training in postgraduate medical education: a scoping review. Med Educ. 2019;53(12):1209-1220.

    Article  PubMed  Google Scholar 

  25. Yardley S, Teunissen PW, Dornan T. Experiential learning: transforming theory into practice. Med Teach. 2012;34(2):161-4.

    Article  PubMed  Google Scholar 

  26. Verma S, Flynn L, Seguin R. Faculty’s and residents’ perceptions of teaching and evaluating the role of health advocate: a study at one Canadian university. Acad Med. 2005;80(1):103-8.

    Article  PubMed  Google Scholar 

  27. Aliani R, Dreiling A, Sanchez J, Price J, Dierks MK, Stoltzfus K. Health advocacy and training perceptions: a comparison of medical student opinions. Med Sci Educ. 2021;31(6):1951-1956.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Law M, Leung P, Veinot P, Miller D, Mylopoulos M. A qualitative study of the experiences and factors that led physicians to be lifelong health advocates. Acad Med. 2016;91(10):1392-1397.

    Article  PubMed  PubMed Central  Google Scholar 

  29. LaDonna KA, Watling CJ, Cristancho SM, Burm S. Exploring patients’ and physicians’ perspectives about competent health advocacy. Med Educ. 2021;55(4):486-495.

    Article  PubMed  Google Scholar 

  30. Warwick S, Kantor L, Ahart E, Twist K, Mabry T, Stoltzfus K. Physician advocacy: identifying motivations for work beyond clinical practice. Kans J Med. 2022;15:433-436.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Shah SI, Brumberg HL. Advocating for advocacy in pediatrics: supporting lifelong career trajectories. Pediatrics. 2014;134(6):e1523-7.

    Article  PubMed  Google Scholar 

  32. Shah S, Brumberg HL, Kuo A, Balasubramaniam V, Wong S, Opipari V. Academic advocacy and promotion: how to climb a ladder not yet built. J Pediatr. 2019;213:4-7.e1.

    Article  PubMed  Google Scholar 

  33. Nerlinger AL, Shah AN, Beck AF, et al. The advocacy portfolio: a standardized tool for documenting physician advocacy. Acad Med. 2018;93(6):860-868.

    Article  PubMed  Google Scholar 

  34. Bode SM, Hoffman BD, Chapman SH, et al. Academic Careers in Advocacy: Aligning Institutional Values Through Use of an Advocacy Portfolio. Pediatrics. 2022;150(1):e2021055014.

    Article  PubMed  Google Scholar 

  35. Nerlinger AL, Best DL, Shah AN. Advocacy in pediatric academia: charting a path forward. Pediatr Clin North Am. 2023;70(1):11-24.

    Article  PubMed  Google Scholar 

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Acknowledgements:

The authors thank Dr. Tom Cooney, Dr. Ben Hoffman, Dr. Ankita Sagar, and Dr. Lainie Yarris for comments on early drafts of the survey instrument and manuscript.

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Authors and Affiliations

  1. Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA

    Joel R. Burnett MD, Bryanna De Lima MPH, Kelsi Manley MD, Sima S. Desai MD & Elizabeth Eckstrom MD, MPH

  2. UT Health San Antonio Long School of Medicine, San Antonio, TX, USA

    Emily S. Wang MD

  3. Alpert Medical School at Brown University, Providence, RI, USA

    Kelly McGarry MD

  4. University of California, Riverside School of Medicine, Riverside, CA, USA

    Daniel I. Kim MD

  5. Alliance for Academic Internal Medicine, Alexandria, VA, USA

    Michael Kisielewski MA

  6. Emory University School of Medicine, Atlanta, GA, USA

    Tracey L. Henry MD, MPH, MS

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  1. Joel R. Burnett MD
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Correspondence to Joel R. Burnett MD.

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Burnett, J.R., De Lima, B., Wang, E.S. et al. How Are We Teaching Advocacy? A National Survey of Internal Medicine Residency Program Directors. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-08753-3

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