To the Editor:
We applaud Gonzalez and colleagues’1 elective course on health disparities and advocacy, as it informs educators to further improve students’ ability to care for diverse populations. In our 10 years of experience, we have learned that disparities instruction frustrates learners unless it is coupled with opportunities to take action, making advocacy instruction a natural pairing for disparities course work. Advocacy is action by a physician to promote social, economic, educational, and political changes that ameliorate threats to human health.2 Integrating health equity into quality improvement efforts, for example, is a form of advocacy that reduces disparities and is increasingly a part of physicians’ careers.3
Given that most physicians already care for patients that span a diverse range of privilege, and given the growth of populations at risk for disparities, we endorse early mandatory health disparities and advocacy training. We have good evidence that early elective course work successfully empowers students to engage in advocacy.4 Required course work reaches students inexperienced with underserved populations and those unsure of their role in advocacy. Course work needs to occur early enough that students have the opportunity to explore the various forms of advocacy and develop a sense of empowerment and commitment. Research on outcomes of our own required course revealed that many first-year students who were initially “neutral” in their attitudes regarding advocacy had redefined themselves as advocates by the end of the course.5 It is time for medical education to challenge all learners to participate in advocacy efforts for patients facing real-world health challenges.
Monica B. Vela, MD
Associate professor and vice chair for diversity, Department of Medicine, University of Chicago, Chicago, Illinois.
Marshall H. Chin, MD, MPH
Richard Parrillo Family Professor of Healthcare Ethics, Department of Medicine, University of Chicago, Chicago, Illinois.
Valerie G. Press, MD, MPH
Assistant professor, Department of Medicine, University of Chicago, Chicago, Illinois; [email protected]
1. Gonzalez CM, Fox AD, Marantz PR.. The evolution of an elective in health disparities and advocacy: Description of instructional strategies and program evaluation. Acad Med. 2015;90:1636–1640
2. Earnest MA, Wong SL, Federico SG.. Perspective: Physician advocacy: What is it and how do we do it? Acad Med. 2010;85:63–67
3. Chin MH, Clarke AR, Nocon RS, et al. A roadmap and best practices for organizations to reduce racial and ethnic disparities in health care. J Gen Intern Med. 2012;27:992–1000
4. Long JA, Lee RS, Federico S, Battaglia C, Wong S, Earnest M.. Developing leadership and advocacy skills in medical students through service learning. J Public Health Manag Pract. 2011;17:369–372
5. Press VG, Fritz CF, Vela MB.. First-year medical student attitudes about advocacy in medicine across multiple fields of discipline: Analysis of reflective essays. J Racial Ethn Health Disparities. 2015;2:556–564