To the Editor: The article by Croft et al1 is an important addition to the literature calling for formalized training in advocacy at the undergraduate medical level as a component of social responsibility and medical professionalism. The authors conclude, “The main goals of advocacy training are to (1) gain an understanding of the complex system of health care, including its limitations, and (2) learn how to affect positive changes within this system.”
While we agree, we believe that programs must also empower students to feel capable of designing and executing concrete projects in advocacy.2,3 On the basis of our institution’s eight years of experience training in advocacy at the undergraduate level, we believe we need to produce physicians that have an advocacy praxis—with both theory and experience in the real world.
Informal surveys of our program’s students indicate that major barriers to performing advocacy projects include feeling overwhelmed at the size of the problems faced and a sense of being disenfranchised due to their subordinate position in the medical hierarchy. We feel that empowerment via training in specific skills in medical advocacy, including designing and executing projects, creates an avenue to counter these sentiments. Formulating a testable hypothesis or small-scale project helps students chip away at a “monolithic” problem by providing a method for analyzing and countering ill effects of inequity. Moreover, incorporating students into project teams with residents and attendings early in their training will facilitate both the transfer of skills related to project development and a sense of agency to effect change.
Croft et al conclude their article with a quote from Goethe, with which we strongly agree: “Knowing is not enough; we must apply. Willing is not enough; we must do.” Ultimately, we believe that empowering students not just to study, but also to be advocates will create physicians more capable of conceiving and executing the work needed to improve the health of both our patients and the communities we serve.
Ashish Premkumar, MD
Resident, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California. When this letter was written, he was a trainee, Boston University School of Medicine Advocacy Training Program, Boston University School of Medicine, Boston, Massachusetts; firstname.lastname@example.org.
Diane N. Haddad
Trainee and medical student, Boston University School of Medicine Advocacy Training Program, Boston University School of Medicine, Boston, Massachusetts.
Daniel A. Dworkis, MD, PhD
Resident, Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts. When this letter was written, he was a trainee and student coordinator, Boston University School of Medicine Advocacy Training Program, Boston University School of Medicine, Boston, Massachusetts.
1. Croft D, Jay SJ, Meslin EM, Gaffney MM, Odell JD. Perspective: Is it time for advocacy training in medical education? Acad Med. 2012;87:1165–1170
2. Dworkis DA, Wilbur MB, Sandel MT. A framework for designing training in medical advocacy. Acad Med. 2010;85:1549–1550
3. Dharamsi S, Ho A, Spadafora SM, Woollard R. The physician as health advocate: Translating the quest for social responsibility into medical education and practice. Acad Med. 2011;86:1108–1113