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Teaching health advocacy to medical students: a comparison study
Julia Belkowitz1, Lee M Sanders, Chi Zhang
1Departments of Pediatrics (Dr Belkowitz) and Department of Medicine (Drs Agarwal and Lichtstein), University of Miami Miller School of Medicine Regional Medical Campus, Boca Raton, Florida; Department of Pediatrics, Stanford University, Stanford Center for Health Policy, Center for Policy, Outcomes and Prevention, Stanford, California (Dr Sanders); Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida (Drs Zhang and Mechaber); and Department of Pediatrics at Jefferson Medical College of Thomas Jefferson University and Nemours, Jefferson Pediatrics/Nemours, Philadelphia, Pennsylvania (Dr Chung).
Context:
Many encourage service learning and health advocacy training in medical student education, but related evaluation is limited.
Objectives:
To assess (1) impact of a required community health advocacy training for medical students on student attitudes, knowledge, and skills; (2) student characteristics associated with higher advocacy knowledge and skills; and (3) perspectives of community-based organizations (CBOs).
Design:
Cross-sectional surveys.
Setting:
University of Miami Miller School of Medicine (UMMSM) Regional Medical Campus and main campus.
Participants:
Medical students at both UMMSM campuses.
Intervention:
Required community health advocacy training for first- and second-year students including classroom experiences and hands-on project in partnership with a CBO.
Main Outcome Measures:
Student characteristics, health advocacy-related attitudes, self-reported and objective knowledge, and skills. Scores were compared between campuses, with multivariable modeling adjusting for individual student characteristics. Community-based organization perspectives were assessed via separate surveys.
Results:
Ninety-eight (77%) regional campus students (intervention group) and 139 (30%) main campus students (comparison group) completed surveys. Versus the comparison group, the intervention group reported greater: mean knowledge of community health needs: 34.6 versus 31.1 (range: 11-44, P < .01), knowledge about CBOs: 3.0 versus 2.7 (range 1-4, P < .01) and knowledge of community resources: 5.4 versus 2.3 (range, 0-11, P < .01), and mean skill scores: 12.7 versus 10.5 (score range: 4-16, P < .01), following the intervention. Using adjusted analysis across both groups, female gender was associated with higher attitudes score. High level of previous community involvement was associated with higher attitude and skill scores. Higher self-reported educational debt was associated with higher skill scores. Community-based organization perspectives included high satisfaction and a desire to influence the training of future physicians.
Conclusions:
Medical student advocacy training in partnership with community-based organizations could be beneficial in improving student advocacy knowledge and skills in addressing community health issues and in developing sustainable community partnerships.
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