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Advocacy Training for Residents: Insights From Tulane's Internal Medicine Residency Program
Jane Andrews1, Catherine Jones, Jeanette Tetrault
1J. Andrews is assistant professor of medicine, Department of General Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas. The author was assistant professor, Tulane University School of Medicine, New Orleans, Louisiana, at the time of writing. C. Jones is assistant professor, Department of General Internal Medicine and Geriatrics, Tulane University School of Medicine, New Orleans, Louisiana. J. Tetrault is associate professor, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut. K. Coontz is clinical instructor, Department of General Internal Medicine and Geriatrics, Tulane University School of Medicine, New Orleans, Louisiana.
Problem:
Physicians have unique insights into the impact of government policies on vulnerable populations. Sharing these with legislators can help them design policy solutions to address public health challenges such as the opioid epidemic, drug pricing, and gun violence. However, despite widespread interest among residents in advocacy and systems-based change, most physicians receive no formal training in the skills needed to become effective physician-advocates. Advocacy training curricula for residents can equip trainees with skills to bridge this gap.
Approach:
The Advocacy and Leadership Track (ALT) of Tulane University's internal medicine residency program was introduced in fall 2015. It incorporates a mix of skills-building and issue-focused participation, reflected in the portfolio of advocacy experiences to be completed by graduation to achieve Advocacy Distinction. Key features include monthly potluck dinner seminars, a persuasive writing workshop, and partnering with a local or national network on a longitudinal health justice campaign.
Outcomes:
As of June 2018, the ALT has nine residents enrolled. Two residents have graduated with the Advocacy Distinction. The ALT has recruited a cohort of physician-advocate faculty mentors and built a cross-generational advocacy network with over 80 physicians and physicians-in-training. The authors share key lessons learned for residency programs developing their own advocacy training pathways.
Next Steps:
As demands on physicians increasingly include care coordination tasks and the effects of social determinants of health become clearer, advocacy skills are becoming relevant for all physicians. The authors recommend incorporating basic advocacy training for all internal medicine residents in the ambulatory curriculum.