Letters to the Editor
We applaud the efforts described by Dworkis et al at BUSM in developing a longitudinal educational experience in advocacy. They describe a useful framework in which to plan and implement a curriculum where advocacy competencies are developed as a part of physician practice and professionalism. Their program and our LEADS (Leadership Education Advocacy Development Scholarship) program at the University of Colorado, as well as a handful of other programs across the country, represent a growing interest in this type of training. The success of these emerging courses demonstrates the feasibility of implementing such curricula.
In our article, we highlight several examples of physicians incorporating advocacy into their professional roles. Each example emphasizes an advocacy-related competency or skill. We assert that these competencies need to be incorporated into medical training so that every physician achieves some basic level of competence in advocacy. Reaching this goal would require that advocacy become an accepted component of professionalism and that licensing and accrediting bodies recognize it as such. Only through these means will we move beyond our current status of professional aspiration without commensurate professional action. We see these curricular innovations as a critical step in the process toward institutionalizing these values and developing the skills. Given the variation among current programs, an important next step is to promote collaboration and ultimately consensus on a common set of competencies and learning objectives. Achieving this goal will require new funding sources and the creation of new courses at additional medical schools; these courses should be rigorously evaluated and validated through peer review.
To our knowledge, the most organized effort to move this agenda has been through the Center for Medicine as a Profession, which sponsors a grants program supporting such curricular development. A key component of their initiative has been to create dialogue among interested programs and physicians. Perhaps this group could serve as a nidus for a larger conversation.
As we move forward toward the goals stated above, we must keep in mind their purpose. The practice of advocacy should produce measurable outcomes for patients and populations we serve and help create a health system that is more responsive to the health needs of individuals and communities.
Mark A. Earnest, MD, PhD
Associate professor, Department of Medicine, codirector, LEADS Program, and director of interprofessional education, University of Colorado Denver School of Medicine, Aurora, Colorado; firstname.lastname@example.org.
Shale L. Wong, MD, MSPH
Associate professor of pediatrics, codirector, LEADS program, and health policy fellow, Robert Wood Johnson Foundation, University of Colorado Denver School of Medicine, Aurora, Colorado.
Steven G. Federico, MD
Assistant professor of pediatrics and director of school-based health centers, Denver Health, University of Colorado Denver School of Medicine, Aurora, Colorado.