To the Editor:
We are grateful for the Advocacy and Leadership Track created by Andrews and colleagues1 that helps develop residents as future physician–advocates through skills building and issue-focused participation. Beyond the key feature of partnering with a local or national network on a longitudinal justice campaign, we believe it is critical for trainees to learn how to identify and apply a framework to conduct their work, especially to achieve scholarship—no different than Andrews and colleagues’ use of the Kern model for curriculum development.
In our experience of working with medical students and residents through the Latino Medical Student Association Health Policy Summit, we have found that trainees exhibit passion and dedication to addressing public health challenges but lack a fundamental approach to investigating and addressing these problems. At the beginning of our curriculum, we introduce our trainees and their advisors to one of many advocacy or policy frameworks in the literature, the Centers for Disease Control and Prevention policy analytical framework,2 to set an expectation to use a structured, evidence-based approach to investigating and addressing issues. The framework consists of 5 steps: (1) problem identification, (2) policy analysis, (3) strategy and policy development, (4) policy enactment, and (5) policy implementation. Our use of a common framework across over 20 projects per year, with the participation of over 100 trainees, has helped to standardize project quality. The framework helps to guide communication and outcomes between trainees, faculty advisors, and community stakeholders. A structured framework may also help to integrate policy or advocacy content into the standing medical school curriculum through its alignment with curricular competencies (e.g., critical thinking). Ultimately, our trainees have approached advocacy and policy through an evidence-based, academic lens, allowing them to better understand the integration of social determinants of health, clinical care, and academic development as future physicians.
In a culture of evidence-based medicine, shouldn’t we facilitate the same scientific rigor as our trainees undertake policy and advocacy work?
Orlando Ivan Solá, MD, MPH
Assistant clinical professor, Department of Family Medicine, SUNY Downstate Medical Center, Brooklyn, New York; [email protected]
John Paul Sánchez, MD, MPH
Associate dean, Diversity and Inclusion, Rutgers New Jersey Medical School, Newark, New Jersey.
1. Andrews J, Jones C, Tetrault J, Coontz K. Advocacy training for residents: Insights from Tulane’s internal medicine residency program. Acad Med. 2019;94:204–207.
2. Centers for Disease Control and Prevention. CDC’s policy analytical framework. https://www.cdc.gov/policy/analysis/process/analysis.html
. Revised May 2015. Accessed May 20, 2019.