Beyond the Controversy About Advocacy

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As leaders of a work group charged with developing advocacy curricula for medical students at the University of Wisconsin School of Medicine and Public Health (UWSMPH), we applaud the report from Dr. Law and colleagues1 regarding the experiences and factors that lead physicians to be lifelong health advocates. We aim to address the barriers to this goal that we have identified in our curriculum. Our efforts were born out of observations of barriers within our own population of students and faculty members, and these observations align with Law and colleagues’ empirical ones. For example, Law and colleagues observe lack of a formal curriculum on practical skills and collaboration as a barrier to advocacy engagement. We agree that formal training, and especially that which is longitudinal, is critical. Medical students unfortunately often receive isolated “boluses” of information on specific topics that they then never hear of again. The UWSMPH advocacy curriculum is longitudinal, with reinforcement of key concepts throughout basic science and clinical courses. After a dedicated three-day program of formal advocacy training for all medical students at UWSMPH, posttests of students demonstrated significant increases in comfort with, and likelihood of pursing, advocacy after exposure and practice.
Additionally, Law and colleagues note lack of mentorship as a barrier. We argue that advocacy mentors must be made as readily available to students as are research and career advising mentors, if indeed we wish to graduate students who are advocates. One way we addressed this was through the development and promotion of an online resource that lists our institution’s faculty members who are willing to mentor medical students about advocacy.2
We concur that all physicians, not just those so inclined, should be advocates. Individual patient advocacy, such as using community resources to facilitate continuity of care, should be the minimum expected. We are delighted that Law and colleagues did not even mention what has previously been noted within Academic Medicine to be a controversy: whether medical students should be trained in advocacy at all.3 We hope we are beyond that controversy, and we congratulate Law and colleagues for a step in that direction.
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