To the Editor:
Research points to increasing rates of medical student and resident burnout and its consequences.1 In response, institutions nationwide are establishing initiatives to improve trainee well-being. Despite increased awareness, one important intervention is rarely mentioned: the incorporation of advocacy training throughout medical education.
Medical school and residency are optimal times for advocacy experiences. Trainees often feel frustrated when faced with inadequate social services for their patients or when limited by strict regulations from hospital administrators, insurance companies, and governmental policies. This sense of powerlessness increases burnout and may deter learners from working with underserved and vulnerable populations—those who need the most help. To combat these trends, trainees should be taught skills to (1) understand how policies are created and implemented and (2) constructively voice their dissatisfaction about societal issues, positively influencing the health of themselves and their patients.
Formal training in advocacy has been shown to change attitudes towards practice even among physicians without preexisting interest in advocacy.2 Early engagement in advocacy fosters a commitment to underserved and vulnerable patient populations and a heightened awareness of the social responsibilities of physicians. More important, empowering trainees with skills to effect positive community or policy change may increases physicians’ sense of personal accomplishment and overall career satisfaction. While trainees may not feel as though each single patient interaction creates change, their broader engagement in societal issues offers the rewards of working towards overall community improvement.
Medical schools must emphasize knowledge of health policy and advocacy as they do disease pathophysiology and pharmacology. Such a foundation facilitates residency experiences that create partnerships at the community, state, or federal level, emphasizing the interdisciplinary nature of medicine and thereby establishing a sense of community support and team resiliency. This hands-on learning could reinforce the benefits of advocacy in reducing burnout, especially when compared with the current fee-for-service system, which places less value on advocacy in favor of more revenue-generating activities. More research is still needed about the effect of advocacy training on learner well-being.
Many students, residents, and physicians are burned out, complaining about the current state of medicine, but few participate in activities to create meaningful change.3 Incorporating advocacy training into medical education can empower physicians to engage in community improvement, thereby affecting patient health. While advocacy training cannot ameliorate all factors contributing to burnout, it can create more sustainable and resilient physicians with a sense of agency to effect change.
Anastasia J. Coutinho, MD, MHS
Second-year family medicine resident, Santa Rosa Family Medicine Residency Program, Santa Rosa, California; [email protected]
Kristina E. Dakis, MD
Second-year family medicine resident, Department of Family Medicine, University of Illinois College of Medicine, Chicago, Illinois.
1. Ghodasara SL, Davidson MA, Reich MS, Savoie CV, Rodgers SM. Assessing student mental health at the Vanderbilt University School of Medicine. Acad Med. 2011;86:116121.
2. Leveridge M, Beiko D, Wilson JW, Siemens DR. Health advocacy training in urology: A Canadian survey on attitudes and experience in residency. Can Urol Assoc J. 2007;1:363369.
3. Gruen RL, Campbell EG, Blumenthal D. Public roles of US physicians: Community participation, political involvement, and collective advocacy. JAMA. 2006;296:24672475.