Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Center for Addictions and Mental Health (CAMH), 1001 Queen Street West, Toronto, Ontario, M6J 1H4, Canada.
BMC Med Educ. 2021 Jan 21;21(1):65. doi: 10.1186/s12909-021-02489-y.
Physicians are in a position of great influence to advocate for health equity. As such, it is important for physicians-in-training to develop the knowledge and skills necessary to fulfil this role. Although various undergraduate medical programs have implemented health advocacy training, they often lack experiential learning and physician involvement. These aspects are foundational to the Advocacy Mentorship Initiative (AMI) which utilizes cascading mentorship as a novel approach to advocacy training. Medical students develop advocacy competency as peer mentors to youth raised in at-risk environments, while also being mentored themselves by physician residents. We aim to determine whether there are specific advantages to utilizing cascading mentorship to facilitate the attainment of advocacy competencies in undergraduate medical education.
Medical students participating in AMI between 2017 to 2020 completed pre- and post-exposure questionnaires. Questionnaires assessed confidence in advocacy-related skills and knowledge of youth advocacy concepts, as well as learning goals, skills gained, benefits of AMI and resident mentors, and impact on future career. Sign tests were utilized to analyze quantitative results, and content analysis was used for open-ended responses. A triangulation protocol was also utilized.
Fifty mentors participated, 24 (48%) of which completed both pre- and post-exposure questionnaires. Participants gained confidence in advocacy-related skills (p < 0.05) such as working with vulnerable populations and advocating for medical and non-medical needs. They also reported significant improvements (p < 0.01) in their understanding of social determinants of health and concepts related to children's health and development. Content analysis showed that participants built meaningful relationships with mentees in which they learned about social determinants of health, youth advocacy, and developed various advocacy-related skills. Participants greatly valued mentorship by residents, identifying benefits such as support and advice regarding relations with at-risk youth, and career mentorship. AMI impacted participants' career trajectories in terms of interest in working with youth, psychiatry, and advocacy.
AMI offers a unique method of advocacy training through cascading mentorship that engages medical students both as mentors to at-risk youth and mentees to resident physicians. Through cascading mentorship, medical students advance in their advocacy-related skills and understanding of social determinants of health.
医生在倡导健康公平方面具有很大的影响力。因此，对于医学生来说，培养履行这一角色所需的知识和技能非常重要。尽管各种本科医学课程都已经实施了健康宣传培训，但这些课程往往缺乏实践学习和医生的参与。这些方面是倡导指导计划（AMI）的基础，该计划利用级联指导作为倡导培训的一种新方法。医学生作为同伴导师，为成长在高风险环境中的年轻人提供宣传方面的帮助，同时也接受住院医师的指导。我们旨在确定利用级联指导来促进本科医学教育中倡导能力的获得是否具有特定的优势。
2017 年至 2020 年间，参与 AMI 的医学生完成了暴露前和暴露后问卷。问卷评估了与倡导相关的技能的信心以及对青年倡导概念的了解，还评估了学习目标、获得的技能、AMI 和住院医师导师的好处，以及对未来职业的影响。符号检验用于分析定量结果，内容分析用于开放性回答。还利用了三角协议。
共有 50 名导师参与，其中 24 名（48%）完成了暴露前和暴露后问卷。参与者在与倡导相关的技能方面获得了信心（p<0.05），例如与弱势群体合作和倡导医疗和非医疗需求。他们还报告说，他们对健康的社会决定因素和与儿童健康和发展相关的概念的理解有了显著的提高（p<0.01）。内容分析表明，参与者与被指导者建立了有意义的关系，从中他们了解了健康的社会决定因素、青年倡导，并发展了各种与倡导相关的技能。参与者非常重视住院医师的指导，认为这对与高风险青年的关系以及职业指导有帮助。AMI 影响了参与者的职业轨迹，他们对与青年、精神病学和倡导工作产生了兴趣。
AMI 通过级联指导提供了一种独特的倡导培训方法，使医学生既能作为高危青年的导师，又能作为住院医师的学员。通过级联指导，医学生在与倡导相关的技能和对健康的社会决定因素的理解方面都有所提高。
