Endres Kaitlin, Burm Sarah, Weiman Daniel, Karol Dalia, Dudek Nancy, Cowley Lindsay, LaDonna Kori
Department of Medicine, University of Ottawa, Ottawa, Canada.
Department of Medicine, Dalhousie University, Halifax, Canada.
Med Teach. 2022 Jan;44(1):79-86. doi: 10.1080/0142159X.2021.1967905. Epub 2021 Sep 27.
There may be no competency more shrouded in uncertainty than health advocacy (HA), raising questions about the robustness of advocacy training in postgraduate medical education. By understanding how programs currently train HA, we can identify whether trainees' learning needs are being met.
From 2017 to 2019, we reviewed curricular documents across nine direct-entry specialties at all Ontario medical schools, comparing content for the HA and communicator roles to delineate role-specific challenges. We then conducted semi-structured interviews with trainees ( = 9) and faculty ( = 6) to review findings and discuss their impact. Data were analyzed using thematic content analysis.
Curricular documents revealed vague objectives and ill-defined modes of assessment for both intrinsic roles. This uncertainty was perceived as more problematic for HA, in part because HA seemed both undervalued in, and disconnected from, clinical learning. Trainees felt that the onus was on them to figure out how to develop and demonstrate HA competence, causing many to turn their learning attention elsewhere.
Lack of curricular focus seems to create the perception that advocacy isn't valuable, deterring trainees-even those keen to become competent advocates-from developing HA skills. Such ambivalence may have troubling downstream effects for both patient care and trainees' professional development.
或许没有哪种能力比健康倡导（HA）更笼罩在不确定性之中了，这引发了关于研究生医学教育中倡导培训稳健性的问题。通过了解当前各项目如何培训健康倡导，我们能够确定学员的学习需求是否得到满足。
2017年至2019年期间，我们审查了安大略省所有医学院九种直接入学专业的课程文件，比较了健康倡导和沟通者角色的内容，以勾勒特定角色面临的挑战。然后，我们对学员（n = 9）和教员（n = 6）进行了半结构化访谈，以审视研究结果并讨论其影响。采用主题内容分析法对数据进行分析。
课程文件显示，这两个内在角色的目标模糊，评估方式不明确。这种不确定性对健康倡导而言似乎问题更大，部分原因在于健康倡导在临床学习中似乎既被低估又与临床学习脱节。学员们觉得要由他们自己去弄清楚如何培养和展示健康倡导能力，这使得许多人将学习注意力转向其他方面。
课程缺乏重点似乎导致人们认为倡导没有价值，这阻碍了学员——甚至那些渴望成为合格倡导者的学员——培养健康倡导技能。这种矛盾心理可能会对患者护理和学员的职业发展产生令人不安的下游影响。
