LO36: The state of advocacy in postgraduate medical education: a literature review

Introduction: Health advocacy training is an important part of emergency medicine practice and education. There is little agreement, however, about how advocacy should be taught and evaluated in the postgraduate context, and there is no consolidated evidence-base to guide the design and implementation of post-graduate health advocacy curricula. This literature review aims to identify existing models used for teaching and evaluating advocacy training, and to integrate these findings with current best-practices in medical education to develop practical, generalizable recommendations for those involved in the design of postgraduate advocacy training programs. Methods: Ovid MEDLINE and PubMed searches combined both MeSH and non-MeSH variations on advocacy and internship and residency. Forward snowballing that incorporated grey literature searches from accreditation agencies, residency websites and reports were included. Articles were excluded if unrelated to advocacy and postgraduate medical education. Results: 507 articles were identified in the search. A total of 108 peer reviewed articles and 38 grey literature resources were included in the final analysis. Results show that many regulatory bodies and residency programs integrate advocacy training into their mission statements and curricula, but they are not prescriptive about training methods or assessment strategies. Barriers to advocacy training were identified, most notably confusion about the definition of the advocate role and a lower value placed on advocacy by trainees and educators. Common training methods included didactic modules, standardized patient encounters, and clinical exposure to vulnerable populations. Longitudinal exposure was less common but appeared the most promising, often linked to scholarly or policy objectives. Conclusion: This review indicates that postgraduate medical education advocacy curricula are largely designed in an ad-hoc fashion with little consistency across programs even within a given discipline. Longitudinal curriculum design appears to engage residents and allows for achievement of stated outcomes. Residency program directors from emergency medicine and other specialties may benefit from promising models in pediatrics, and a shared portal with access to advocacy curricula and the opportunity to exchange ideas related to curriculum design and implementation.

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The state of health advocacy training in postgraduate medical education: a scoping review

Medical Education ◽

10.1111/medu.13929 ◽

2019 ◽

Vol 53 (12) ◽

pp. 1209-1220 ◽

Cited By ~ 4

Author(s):

Madeline McDonald ◽

Conor Lavelle ◽

Mei Wen ◽

Jonathan Sherbino ◽

Jennifer Hulme

Keyword(s):

Medical Education ◽

Scoping Review ◽

Postgraduate Medical Education ◽

The State ◽

State Of Health ◽

Health Advocacy ◽

Advocacy Training

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LO093: A national needs assessment survey for the development of a quality improvement and patient safety curriculum for Canadian emergency medicine residents

CJEM ◽

10.1017/cem.2016.130 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S62-S62 ◽

Cited By ~ 1

Author(s):

L.B. Chartier ◽

S. Vaillancourt ◽

M. McGowan ◽

K. Dainty ◽

A.H. Cheng

Keyword(s):

Emergency Medicine ◽

Medical Education ◽

Patient Safety ◽

Quality Improvement ◽

Needs Assessment ◽

Residency Training ◽

Royal College ◽

Assessment Tool ◽

Postgraduate Medical Education ◽

Clinical Scenarios

Introduction: The Canadian Medical Education Directives for Specialists (CanMEDS) framework defines the competencies that postgraduate medical education programs must cover for resident physicians. The 2015 iteration of the CanMEDS framework emphasizes Quality Improvement and Patient Safety (QIPS), given their role in the provision of high value and cost-effective care. However, the opinion of Emergency Medicine (EM) program directors (PDs) regarding the need for QIPS curricula is unknown, as is the current level of knowledge of EM residents in QIPS principles. We therefore sought to determine the need for a QIPS curriculum for EM residents in a Canadian Royal College EM program. Methods: We developed a national multi-modal needs assessment. This included a survey of all Royal College EM residency PDs across Canada, as well as an evaluative assessment of baseline QIPS knowledge of 30 EM residents at the University of Toronto (UT). The resident evaluation was done using the validated Revised QI Knowledge Application Tool (QIKAT-R), which evaluates an individual’s ability to decipher a systematic quality problem from short clinical scenarios and to propose change initiatives for improvement. Results: Eight of the 13 (62%) PDs responded to the survey, unanimously agreeing that QIPS should be a formal part of residency training. However, challenges identified included the lack of qualified and available faculty to develop and teach QIPS material. 30 of 30 (100%) residents spanning three cohorts completed the QIKAT-R. Median overall score was 11 out of 27 points (IQR 9-14), demonstrating the lack of poor baseline QIPS knowledge amongst residents. Conclusion: QIPS is felt to be a necessary part of residency training, but the lack of available and qualified faculty makes developing and implementing such curriculum challenging. Residents at UT consistently performed poorly on a validated QIPS assessment tool, confirming the need for a formal QIPS curriculum. We are now developing a longitudinal, evidence-based QIPS curriculum that trains both residents and faculty to contribute to QI projects at the institution level.

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Organisational perspectives on addressing differential attainment in postgraduate medical education: a qualitative study in the UK

BMJ Open ◽

10.1136/bmjopen-2017-021314 ◽

2018 ◽

Vol 8 (3) ◽

pp. e021314 ◽

Cited By ~ 10

Author(s):

Katherine Woolf ◽

Rowena Viney ◽

Antonia Rich ◽

Hirosha Jayaweera ◽

Ann Griffin

Keyword(s):

Medical Education ◽

Curriculum Design ◽

Postgraduate Medical Education ◽

Change Strategies ◽

Effect Change ◽

Medical Graduates ◽

Minority Ethnic Groups ◽

The Uk ◽

Evaluation Of Evidence ◽

Minority Ethnic

ObjectivesTo explore how representatives from organisations with responsibility for doctors in training perceive risks to the educational progression of UK medical graduates from black and minority ethnic groups (BME UKGs), and graduates of non-UK medical schools (international medical graduates (IMGs)). To identify the barriers to and facilitators of change.DesignQualitative semistructured individual and group interview study.SettingPostgraduate medical education in the UK.ParticipantsIndividuals with roles in examinations and/or curriculum design from UK medical Royal Colleges. Employees of NHS Employers.ResultsRepresentatives from 11 medical Royal Colleges (n=29) and NHS Employers (n=2) took part (55% medically qualified, 61% male, 71% white British/Irish, 23% Asian/Asian British, 6% missing ethnicity). Risks were perceived as significant, although more so for IMGs than for BME UKGs. Participants based significance ratings on evidence obtained largely through personal experience. A lack of evidence led to downgrading of significance. Participants were pessimistic about effecting change, two main barriers being sensitivities around race and the isolation of interventions. Participants felt that organisations should acknowledge problems, but felt concerned about being transparent without a solution; and talking about race with trainees was felt to be difficult. Participants mentioned 63 schemes aiming to address differential attainment, but these were typically local or specialty-specific, were not aimed at BME UKGs and were largely unevaluated. Participants felt that national change was needed, but only felt empowered to effect change locally or within their specialty.ConclusionsRepresentatives from organisations responsible for training doctors perceived the risks faced by BME UKGs and IMGs as significant but difficult to change. Strategies to help organisations address these risks include: increased openness to discussing race (including ethnic differences in attainment among UKGs); better sharing of information and resources nationally to empower organisations to effect change locally and within specialties; and evaluation of evidence-based interventions.

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The importance of health advocacy in Canadian postgraduate medical education: current attitudes and issues

Canadian Medical Education Journal ◽

10.36834/cmej.36665 ◽

2015 ◽

Vol 6 (2) ◽

pp. e54-e60 ◽

Cited By ~ 4

Author(s):

Alexander Poulton ◽

Heather Rose

Keyword(s):

Medical Education ◽

Postgraduate Medical Education ◽

Pediatric Emergency ◽

Role Modeling ◽

Pediatric Emergency Medicine ◽

Health Advocacy ◽

Current State ◽

Health Advocate ◽

The Subject

Background: Health advocacy is currently a key component of medical education in North America. In Canada, Health Advocate is one of the seven roles included in the Royal College of Physicians and Surgeons of Canada’s CanMEDS competency framework.Method: A literature search was undertaken to determine the current state of health advocacy in Canadian postgraduate medical education and to identify issues facing educators and learners with regards to health advocacy training.Results: The literature revealed that the Health Advocate role is considered among the least relevant to clinical practice by educators and learners and among the most challenging to teach and assess. Furthermore learners feel their educational needs are not being met in this area. A number of key barriers affecting health advocacy education were identified including limited published material on the subject, lack of clarity within the role, insufficient explicit role modeling in practice, and lack of a gold standard for assessment. Health advocacy is defined and its importance to medical practice is highlighted, using pediatric emergency medicine as an example.Conclusions: Increased published literature and awareness of the role, along with integration of the new 2015 CanMEDS framework, are important going forward to address concerns regarding the quality of postgraduate health advocacy education in Canada.

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A realist synthesis of quality improvement curricula in undergraduate and postgraduate medical education: what works, for whom, and in what contexts?

BMJ Quality & Safety ◽

10.1136/bmjqs-2020-010887 ◽

2020 ◽

pp. bmjqs-2020-010887 ◽

Cited By ~ 1

Author(s):

Allison Brown ◽

Kyle Lafreniere ◽

David Freedman ◽

Aditya Nidumolu ◽

Matthew Mancuso ◽

...

Keyword(s):

Medical Education ◽

Quality Improvement ◽

Clinical Outcomes ◽

Postgraduate Medical Education ◽

Grey Literature ◽

Realist Synthesis ◽

Programme Theory ◽

Protected Time ◽

What Works ◽

Competency Area

BackgroundWith the integration of quality improvement (QI) into competency-based models of physician training, there is an increasing requirement for medical students and residents to demonstrate competence in QI. There may be factors that commonly facilitate or inhibit the desired outcomes of QI curricula in undergraduate and postgraduate medical education. The purpose of this review was to synthesise attributes of QI curricula in undergraduate and postgraduate medical education associated with curricular outcomes.MethodsA realist synthesis of peer-reviewed and grey literature was conducted to identify the common contexts, mechanisms, and outcomes of QI curricula in undergraduate and postgraduate medical education in order to develop a programme theory to articulate what works, for whom, and in what contexts.Results18854 records underwent title and abstract screening, full texts of 609 records were appraised for eligibility, data were extracted from 358 studies, and 218 studies were included in the development and refinement of the final programme theory. Contexts included curricular strategies, levels of training, clinical settings, and organisational culture. Mechanisms were identified within the overall QI curricula itself (eg, clear expectations and deliverables, and protected time), in the didactic components (ie, content delivery strategies), and within the experiential components (eg, topic selection strategies, working with others, and mentorship). Mechanisms were often associated with certain contexts to promote educational and clinical outcomes.ConclusionThis research describes the various pedagogical strategies for teaching QI to medical learners and highlights the contexts and mechanisms that could potentially account for differences in educational and clinical outcomes of QI curricula. Educators may benefit from considering these contexts and mechanisms in the design and implementation of QI curricula to optimise the outcomes of training in this competency area.

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Dermatologic Training and Practice in Canada: An In-Depth Review

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475420914619 ◽

2020 ◽

Vol 24 (3) ◽

pp. 297-303

Author(s):

P. Régine Mydlarski ◽

Laurie M. Parsons ◽

Tadeusz A. Pierscianowski ◽

Mark G. Kirchhof ◽

Cheryl F. Rosen ◽

...

Keyword(s):

Medical Education ◽

Literature Review ◽

Royal College ◽

Postgraduate Medical Education ◽

Wait Times ◽

Stakeholder Perspectives ◽

Current State ◽

Preliminary Research ◽

Specialty Education ◽

And Training

As part of an in-depth review of the specialty for the Royal College of Physicians and Surgeons of Canada (RCPSC), the Dermatology Working Group (DWG) was tasked with leading a comprehensive and objective analysis of the current state of Dermatology practice and training patterns in Canada. Preliminary research for the report was conducted in 3 areas: a jurisdictional analysis, a literature review, and a landscape overview. The results of this research were published in the spring 2019 edition of the Journal of Cutaneous Medicine and Surgery. Various factors impacting the discipline were explored, including trends in the workforce, population needs, accessibility, and wait times, as well as issues in undergraduate and postgraduate medical education. The DWG, supported by the RCPSC’s Office of Specialty Education, used information gained from the reviews, a national survey, and stakeholder perspectives to develop recommendations that address the current challenges and build upon opportunities for advancement in the specialty.

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