Health Advocate Role

Report
Preparing Future Physicians for the
CanMEDS Health Advocate Role: A
work in progress
Medical Education Rounds
April 7, 2010
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S. Dharamsi & I. Scott (RCPSC Funded Research)
S. Dharamsi & F. Shroff (FDIG)
L. Mu (Community Med Resident)
Department of Family Practice
Requests for community- & social responsiveness
Smilkstein G. Designing a curriculum for training community-responsive
physicians. J Healthcare Poor Underserved. 1990;1(2):237-42.
Rubenstein HL, Franklin ED, Zarro VJ. Opportunities and challenges in
educating community-responsive physicians. Am J Prev Med.
1997;13(2):104-8.
Peabody J. Measuring the social responsiveness of medical schools: Setting
standards. Acad Med. 1999;74:59-68.
Brill JR, Ohly S, Stearns MA. Training community-responsive physicians. Acad
Med. 2002;77(7):747.
Oandasan I, Malik R, Waters I, Lambert-Lanning A. Being communityresponsive physicians. Doing the right thing. Can Fam Physician.
2004;50:1004-10.
Social accountability
Parboosingh J. Medical schools’ social contract: more than just
education and research. Can Med Assoc J. 2003;168(7):852-3.
Woollard RF. Caring for a common future: medical schools’ social
accountability. Med Educ 2006;40:301-313.
Rourke J. Social accountability in theory and practice. Ann Fam Med.
2006;4(1):S45-8; discussion S58-60.
Verma S. Honouring the social contract: medical schools take social
responsibility seriously. University of Toronto Bulletin (November 14,
2005) Website. http://www.afmc.ca/docs/2005_social_contract.pdf
Accessed October 16, 2007.
Boelen C, Woollard B. Social accountability and accreditation: a new
frontier for educational institutions. Med Educ. 2009;43(9):887-94.
Committee on Accreditation of Canadian Medical Schools
(CACMS)
&
Liaison Committee on Medical Education (LCME)
“healthcare disparities and the development of solutions to
such burdens,
the importance of meeting the healthcare needs of
medically underserved populations ... and
[about] core professional attributes, such as altruism and
social accountability...”
Health Advocate Role
Frank JR, Langer B. Collaboration, communication, management, and
advocacy: teaching surgeons new skills through the CanMEDS
Project. World J Surg. 2003;27(8):972-8.
“vulnerable or marginalized”
“the ethical and professional issues inherent in health advocacy,
including altruism, social justice, autonomy, integrity and
idealism.”
Health Advocate Role
As Health Advocates, physicians responsibly use their expertise and influence to
advance the health and well-being of individual patients, communities, and
populations.
Identify opportunities for advocacy, health promotion and disease prevention
in the communities that they serve, and respond appropriately
Identify the determinants of health of the populations, including barriers to
access to care and resources; and implement a change
Identify vulnerable or marginalized populations within those served and respond
appropriately
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 Nov;1(4):363-9.
Oandasan IF. Health advocacy: bringing clarity to educators through
the voices of physician health advocates. Acad Med
2005;80(10):S38-41.
Verma S, Flynn L, Seguin R. Faculty’s and residents’ perceptions of
teaching and evaluating the role of health advocate: a study at one
Canadian university. Acad Med 2005;80:103-8.
Oandasan IF, Barker KK. Educating for advocacy: exploring the source
and substance of community-responsive physicians. Acad Med
2003;78(10):S16-9.
Herbert CP. The fifth principle. Family physicians as advocates. Can
Fam Physician 2001;47:2441-3, 2448-51.
Dharamsi & Scott Study
Interviews and focus groups
1.
2.
To explore Program Directors’ perspectives on the
CanMEDS role of the physician as Health Advocate;
How the competencies related to health advocacy
can best be addressed in residency training.
Case Study
Your Department has recently had a Royal College review and received
accolades for strengths in the Medical Expert Role. However, the
Department as been cited for deficiency in the Health Advocate Role
(HA).
The Residency Program Committee has been gathered to discuss the
matter. The Committee has brought in an expert for advice. The expert
suggests that efforts to integrate HA into the training program is likely
to be more effective if it is undertaken using a participatory approach
(i.e., actively involving learners).
The Committee is convinced and decides to involve the Urology residents
in reviewing the identified weaknesses in the existing curriculum, and
to develop a plan to correct them with a focus on the Health Advocate
Role.
A session with the residents is organized. The expert gives an
interactive presentation on the HA role and invites questions at the
end.
After an awkward silence, one resident says:
“Health advocacy is important but we really need to develop
proficiency in clinical and surgical skills…the other ‘stuff’ we can
figure out later, once we get going in our careers.”
Several residents nod in agreement.
Faculty Development Initiatives Grant
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To create an educational primer on Health Advocacy
(HA) for post-graduate medical educators
Co-Investigator: Dr. Farah Shroff
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Adjunct Professor in the Department of Family Practice at UBC.
Health Advocate Role: Key
Competencies
Physicians are able to…
Respond to individual patient health needs and
issues as part of patient care;
Respond to the health needs of the communities
that they serve;
Identify the determinants of health of the
populations that they serve;
Promote the health of individual patients,
communities and populations.
2. Respond to the health needs of the
communities that they serve;
2.1. Describe the practice communities that they serve
2.2. Identify opportunities for advocacy, health promotion and
disease prevention in the communities that they serve, and
respond appropriately
2.3. Appreciate the possibility of competing interests between
the communities served and other populations
3. Identify the determinants of health
for the populations that they serve
3.1. Identify the determinants of health of the populations,
including barriers to access to care and resources
3.2. Identify vulnerable or marginalized populations within
those served and respond appropriately
4. Promote the health of individual
patients, communities, and
populations
4.1. Describe an approach to implementing a change in
determinant of health of the populations they serve
4.2. Describe how public policy impacts on the health of the
populations served
4.3. Identify points of influence in the healthcare system and
its structure
4.4. Describe the ethical and professional issues inherent in
health advocacy, including altruism, social justice,
autonomy, integrity and idealism
a

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