Division of Internal Medicine and Pediatrics, Department of Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.
Palliative Care Program, Division of General Internal Medicine & Health Services Research, Department of Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.
J Gen Intern Med. 2023 Sep;38(12):2792-2807. doi: 10.1007/s11606-023-08244-x. Epub 2023 Jun 20.
Advocacy is an integral component of a physician's professional responsibilities, yet efforts to teach advocacy skills in a systematic and comprehensive manner have been inconsistent and challenging. There is currently no consensus on the tools and content that should be included in advocacy curricula for graduate medical trainees.
To conduct a systematic review of recently published GME advocacy curricula and delineate foundational concepts and topics in advocacy education that are pertinent to trainees across specialties and career paths.
We conducted an updated systematic review based off Howell et al. (J Gen Intern Med 34(11):2592-2601, 2019) to identify articles published between September 2017 and March 2022 that described GME advocacy curricula developed in the USA and Canada. Searches of grey literature were used to find citations potentially missed by the search strategy. Articles were independently reviewed by two authors to identify those meeting our inclusion and exclusion criteria; a third author resolved discrepancies. Three reviewers used a web-based interface to extract curricular details from the final selection of articles. Two reviewers conducted a detailed analysis of recurring themes in curricular design and implementation.
Of 867 articles reviewed, 26 articles, describing 31 unique curricula, met inclusion and exclusion criteria. The majority (84%) represented Internal Medicine, Family Medicine, Pediatrics, and Psychiatry programs. The most common learning methods included experiential learning, didactics, and project-based work. Most covered community partnerships (58%) and legislative advocacy (58%) as advocacy tools and social determinants of health (58%) as an educational topic. Evaluation results were inconsistently reported. Analysis of recurring themes showed that advocacy curricula benefit from an overarching culture supportive of advocacy education and should ideally be learner-centric, educator-friendly, and action-oriented.
Combining core features of advocacy curricula identified in prior publications with our findings, we propose an integrative framework to guide design and implementation of advocacy curricula for GME trainees. Additional research is needed to build expert consensus and ultimately develop model curricula for disseminated use.
倡导是医生专业职责的一个组成部分，但以系统和全面的方式教授倡导技能的努力一直不一致且具有挑战性。目前，对于研究生医学培训生的倡导课程应该包含哪些工具和内容，尚无共识。
对最近发表的研究生医学教育倡导课程进行系统回顾，并阐明与跨专业和职业路径的受训者相关的倡导教育的基础概念和主题。
我们根据 Howell 等人的研究（J Gen Intern Med 34(11):2592-2601, 2019）进行了更新的系统回顾，以确定描述在 2017 年 9 月至 2022 年 3 月期间在美国和加拿大开发的研究生医学教育倡导课程的文章。搜索灰色文献以查找搜索策略可能遗漏的引文。由两位作者独立审查文章，以确定符合我们的纳入和排除标准的文章；第三位作者解决了差异。三位审阅者使用基于网络的界面从最终选择的文章中提取课程详细信息。两位审阅者对课程设计和实施中的反复出现的主题进行了详细分析。
在审查的 867 篇文章中，有 26 篇文章，描述了 31 个独特的课程，符合纳入和排除标准。其中大多数（84%）代表内科、家庭医学、儿科学和精神病学项目。最常见的学习方法包括体验式学习、讲座和基于项目的工作。大多数涵盖社区伙伴关系（58%）和立法倡导（58%）作为倡导工具和健康的社会决定因素（58%）作为教育主题。评估结果报告不一致。对反复出现的主题的分析表明，倡导课程受益于支持倡导教育的总体文化，并且理想情况下应该以学习者为中心、教育者友好且面向行动。
结合之前出版物中确定的倡导课程的核心特征和我们的发现，我们提出了一个综合框架，以指导研究生医学培训生的倡导课程的设计和实施。需要进一步的研究来建立专家共识，并最终为推广使用开发示范课程。
