A Framework for Designing Training in Medical Advocacy

To the Editor:

In their January article, Earnest et al¹ adeptly highlight the need for the creation and delivery of more formalized training in medical advocacy. Toward this worthwhile goal, we offer the following framework of learning objectives, derived from our experiences teaching advocacy to medical students at the Boston University School of Medicine (BUSM). Our program is student-led in conjunction with mentorship from faculty at BUSM and the professional advocates at the National Center for Medical–Legal Partnership.² Over the past six years, it has evolved from a single elective to a multiyear curriculum with both clinical and preclinical components. The learning objectives we present here arose from this continuing curricular development and might provide a starting point for other institutions interested in designing formalized training in medical advocacy for medical students.

To skillfully engage in the types of advocacy that Earnest et al describe, medical students need to develop skills in advocacy theory, execution, and communication. Formal study of the theory of advocacy helps medical students define their roles as advocates and explore their positions along the spectrum of physician advocacy. Experience in executing defined advocacy projects removes potentially formidable barriers to using advocacy in clinical settings by honing skills and developing both competence and confidence. Finally, training in communication enables medical students to translate clinical observations for wider audiences and to teach advocacy to other medical professionals.

Learning objectives dealing with advocacy theory might include (1) formally identifying and distinguishing between the roles that physicians must, should, and could perform within the spectrum of physician advocacy, and (2) developing a rigorous understanding of the social determinants of health.

Learning objectives centered on advocacy execution might include practice in distilling clinical observations from multiple patients into a well-defined issue in need of advocacy, then engaging in a small-scale advocacy project. Examples include writing an op-ed for a local paper or developing an “advocacy code card” that clerks can use to help their patients receive benefits like Womens, Infants, and Children nutrition vouchers.

Learning objectives dealing with advocacy communication might include completing a press release, oral presentation, or lecture for a nonmedical community, or presenting a patient whose clinical course is complicated by socioeconomic issues to a group of medical peers.

Daniel A. Dworkis

MD–PhD candidate, Department of Molecular Medicine, Boston University School of Medicine, Boston, Massachusetts; [email protected].

MaryAnn B. Wilbur

MD–MPH candidate, Boston University School of Medicine, Boston, Massachusetts.

Megan T. Sandel, MD, MPH

National medical director, National Center for Medical–Legal Partnership, Boston, Massachusetts.