L. Clarke is a medical student, Stanford University School of Medicine, Palo Alto, California; ORCID: https://orcid.org/0000-0003-2647-6819 .
Acad Med. 2024 Sep 1;99(9):953-958. doi: 10.1097/ACM.0000000000005754. Epub 2024 May 7.
Trainees (medical students, residents, and fellows) are beginning to make strides in pushing for changes to their education. While there are many examples of successful trainee-led curriculum reform efforts, the path to success remains unclear. To better understand the process of trainee-driven curricular advocacy, the author analyzes this process through the lens of ecological systems theory (EST) not only to provide readers with context for the barriers and facilitators to trainee-driven curricular advocacy but also to further medical education's understanding of the sociopolitical forces influencing the process of trainee-driven curricular advocacy and reform through the lens of the trainee. EST explains how individuals are influenced by a complex web of social and environmental forces. The theory outlines 5 ecological systems of influence: the microsystem, mesosystem, exosystem, macrosystem, and chronosystem. Using EST to explore the process of trainee-driven curricular advocacy therefore clarifies the many layers of influence that trainees must navigate while advocating for curriculum change. The author then draws on this theory and their own experience as a medical student advocating for local and national curriculum reform to develop a model to facilitate trainee-driven curricular advocacy in medical education. The proposed model outlines concrete steps trainees can take while going through the process of curricular advocacy both within their own institutions and on a national level. Through developing this model, the author hopes not only to empower trainees to become agents of change in medical education but also to encourage faculty members and administrators within health professional training programs to support trainees in these efforts.
学员（医学生、住院医师和研究员）开始在推动教育变革方面取得进展。虽然有许多成功的学员主导课程改革的例子，但成功的途径仍不清楚。为了更好地理解学员驱动课程倡导的过程，作者通过生态系统理论（EST）的视角分析这个过程，不仅为读者提供了学员驱动课程倡导的障碍和促进因素的背景，还通过学员的视角进一步理解影响学员驱动课程倡导和改革的社会政治力量。EST 解释了个人如何受到复杂的社会和环境力量网络的影响。该理论概述了 5 个影响生态系统：微系统、中系统、外系统、宏系统和时间系统。因此，使用 EST 来探索学员驱动课程倡导的过程可以阐明学员在倡导课程变革时必须应对的许多层次的影响。作者随后借鉴了这一理论以及他们自己作为一名倡导当地和全国课程改革的医学生的经验，为医学教育中的学员驱动课程倡导制定了一个模型。该模型提出了学员在机构内部和全国范围内进行课程倡导时可以采取的具体步骤。通过制定该模型，作者不仅希望赋予学员成为医学教育变革推动者的权力，还希望鼓励卫生专业培训项目中的教师和管理人员支持学员的这些努力。
