Advocacy Training Can Give Students, Residents Skills to Improve Community Health

January 27, 2010 04:25 pm Barbara Bein

Incorporating advocacy training into family medicine residencies could rekindle residents' idealism and give them the skills they need to be catalysts for change, particularly in medically underserved populations, says one family medicine educator. And, because there's no defined national advocacy curriculum, residencies are free to explore various options for providing that training, such as offering activism electives, creating a longitudinal curriculum on advocacy or incorporating advocacy training into their community medicine rotations.

The result: happier residents who are adept at developing relationships with government officials and local leaders and who can successfully collaborate with other stakeholders to achieve community health goals. That's according to Cheryl Seymour, M.D., of Augusta, Maine, a faculty member at the Maine-Dartmouth Family Medicine Residency in Augusta and assistant professor of community and family medicine at Dartmouth Medical School, Hanover, N.H.

Seymour said the AAFP and its Residency Program Solutions educational consulting service have established guidelines for meeting the Accreditation Council for Graduate Medical Education's Residency Review Committee leadership requirements, but little of the recommended curriculum is devoted to practical skills or attitudes specific to political or community advocacy.

"Part of the role of a physician should be to advocate for the health of their patients," Seymour told AAFP News Now. "Sometimes this requires action outside the exam room or the hospital. It might be at the community level or the national political level or even within the physician practice.

"Family medicine is the field most oriented to all of the needs of a patient, so every day is full of opportunities to learn about advocacy."

Advocacy Curriculum Possibilities

In a presentation she made during a recent regional meeting of the Society of Teachers of Family Medicine, or STFM, Seymour gave several examples of activities that could be incorporated into an advocacy curriculum, including

  • facilitating a resident project to identify a need in the community, such as new sidewalks or walking trails, and then collaborating with community groups to achieve shared goals;
  • participating in contacting legislators about issues identified in AAFP national legislative updates; and
  • bringing in physician-advocates to participate in roundtable or panel discussions about relevant issues.

Most pediatric residencies include formal training in advocacy, she said, and even a few medical schools, such as Albert Einstein in New York City and the University of New Mexico in Albuquerque, are getting into the act by offering advocacy training in their family medicine clerkships.

In addition, the University of California, San Francisco, School of Medicine has a longitudinal advocacy elective -- "Social Activism in Medicine" -- and Montefiore Medical Center, Bronx, N.Y., offers a health activism elective for fourth-year students, Seymour said. The Public Citizen Health Research Group( also provides listings of health activist courses and curricula.

"National organizations such as the AAFP and the ACOFP (American College of Osteopathic Family Physicians) are energetic participants in the national political debate about health policy and medical education, but not enough residents are aware of this activity," Seymour noted in her STFM presentation materials(

It's especially important that residents realize they can become actively involved in advocacy efforts on a local, regional or national level, said Seymour, who also serves as the medical director of the Maine Migrant Health Program, which provides primary and preventive health care services to migrant and seasonal workers.

Hands-on Experience

At the Maine-Dartmouth Family Medicine Residency, residents study public health data and work with physician-advocates as part of their community medicine rotation, said Seymour. In addition, Seymour teaches an elective about the migrant and seasonal farmworker community in Maine, which includes a multicultural population of American Indians, Latinos and Haitians.

At the height of blueberry harvest season in August, Seymour and the residents use mobile clinics to provide care in the fields and worker camps around Millbridge, Maine, which is a three-hour drive from Augusta. The experience of caring for farmworkers provides compelling case studies about the benefits of advocacy, said Seymour.

For example, about five years ago, a coalition of workers, growers, occupational health specialists and manufacturers of the rakes used for blueberry harvesting came together to decide how to reduce workers' injuries related to use of the rakes, according to Seymour. The coalition came up with a new design for the rake, which the majority of workers use today.

"Advocacy is particularly important when working with medically underserved populations," she said. "We have an opportunity to use our positions to help people. I do believe that many students planning a career in family medicine are hoping to be leaders in their communities and to facilitate change on behalf of those without a voice."

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