Department of Family Practice, Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Department of Family Practice, Faculty of Medicine, University of British Columbia, Nanaimo, BC, Canada.
Med Educ. 2021 Aug;55(8):933-941. doi: 10.1111/medu.14526. Epub 2021 Apr 1.
Health advocacy is a core component of physician competency frameworks. However, advocacy has lacked a clear definition and is understood and enacted variably across contexts. Due to their mobility across contexts, learners are uniquely positioned to provide insight into the tensions that have made this role so difficult to define, but that may be central to this role. The purpose of this study was to map the tensions and contours in conceptions of health advocacy among learners across a variety of learning contexts.
We used constructivist grounded theory and interviewed nine medical students and twenty residents in family, paediatric and internal medicine from across our university's distributed programmes. Data were analysed concurrently using open, focussed and theoretical coding to establish themes and relationships between themes.
Learners understood health advocacy in two overlapping but distinct ways: as a set of behaviours and as a sense of 'going above and beyond', through additional effort, time or risk. These two conceptions overlapped and were often in tension. 'Going above and beyond' sometimes aligned with identifiable advocacy behaviours; at other times, 'going above and beyond' did not align with definitions of health advocacy in competency frameworks and aligned more closely with 'patient-centred care'.
Our findings suggest that learners perceive that there are important elements of health advocacy that cannot be captured in universal behaviours that apply across contexts. 'Going above and beyond' describes a sense of grappling with sociocultural barriers to patient-centred care and striving towards better systems and better care for individuals. This more abstract and contextually bound notion of health advocacy may not lend itself easily to definition in competency frameworks and thus adds challenges to both teaching and assessment.
健康倡导是医师能力框架的核心组成部分。然而，倡导缺乏明确的定义，并且在不同的背景下被理解和执行的方式也各不相同。由于学习者在不同的背景下具有流动性，他们独特地处于能够洞察使这一角色如此难以定义的紧张局势的位置，但这些紧张局势可能是这一角色的核心。本研究的目的是在各种学习背景下，描绘学习者对健康倡导的概念中的紧张局势和轮廓。
我们使用建构主义扎根理论，对来自我们大学分布式项目的家庭医学、儿科和内科的九名医学生和二十名住院医师进行了访谈。使用开放式、聚焦式和理论式编码对数据进行了同时分析，以确定主题和主题之间的关系。
学习者以两种重叠但不同的方式理解健康倡导：作为一组行为，以及通过额外的努力、时间或风险“超越”的感觉。这两种概念重叠，往往存在紧张关系。“超越”有时与可识别的倡导行为一致；在其他时候，“超越”与能力框架中健康倡导的定义不一致，更接近“以患者为中心的护理”。
我们的研究结果表明，学习者认为健康倡导有一些重要的方面无法用适用于各种背景的普遍行为来捕捉。“超越”描述了一种与以患者为中心的护理的社会文化障碍作斗争的感觉，并努力实现更好的系统和更好的个人护理。这种更抽象和上下文相关的健康倡导概念可能不容易在能力框架中定义，因此给教学和评估都带来了挑战。
