Despite the expenditure of vast resources, the US healthcare system faces numerous public health challenges and a failure to provide quality healthcare for everyone in our society. Our system continues to result in inequalities in access to care for vulnerable populations including the uninsured, racial and ethnic minorities, LGBTQ persons, immigrants, prisoners, people with chronic mental illness, and homeless persons. Too often, health policies and medical decision-making are guided by corporate and pharmaceutical interests rather than sound medical and ethical principles.
Physicians have a unique vantage point to identify the social, political and economic forces that adversely affect the care of patients. We can also be highly effective advocates in shaping health policy and in making social change. Yet most physicians are inadequately trained to take advantage of their unique position to engage in advocacy to improve health care systems.
CHA has a rich tradition of advocacy for the poor and disenfranchised. Faculty, staff and trainees have, for instance, co-founded Physicians for Human Rights, coordinated earthquake relief efforts in Haiti, and produced research that has been leveraged on the floor of the US Senate.
In 2012, the CHA Internal Medicine Residency Program transformed a popular elective into a required social medicine and research based health advocacy course. We have described this course in a paper published in Academic Medicine and a news article in Boston Globe Media’s STAT News. Our residency program believes that to meaningfully address health inequities and threats to health and human rights, medical education should play an important role in training future clinicians in the role of health advocate and social change agent.
The social medicine and research based health advocacy curriculum is designed to provide medical residents with knowledge of key health policy issues, social determinants of health, human rights, global poverty and disease, and theoretical foundations of physician advocacy. It also provides training to develop skills to conduct health services research and successfully engage in advocacy on behalf of patients and populations. In our course, residents are exposed to successful and inspiring physician advocates which may encourage careers that incorporate advocacy. Each year residents meet with media professionals at either NPR/WBUR or the Boston Globe.
Course Goals
- Clarify and develop the values that brought residents to train in a residency program committed to the care of underserved populations
- Explore the role physicians can play in addressing systemic health equity
- Improve knowledge of topics in health equity, social determinants of health and health policy
- Develop skills in research methodology, leadership and health advocacy
- Provide mentorship and role modeling to support career development that may incorporate health advocacy
Course Format
One third of internal medicine residents each year (roughly equal proportions from each year of training) will participate in this year long experience such that every trainee will participate at some point in their training. Residents participating in the curriculum will meet throughout the year with experts in health policy, research methodology and advocacy in sessions comprised of lectures, skill building workshops, discussion and case studies. Sessions occur both on campus at CHA, and around Cambridge and Boston. The course is delivered during two 2-week immersion blocks in October and February and through various Thursday morning didactic sessions throughout the year.
Although many forms of advocacy exist, emphasis will be placed on research-based advocacy-- the collection and presentation of data in an understandable form to policy makers, government regulators, the media and the general public in order to influence health policy. A highlight of the course is experiential learning through a research based health advocacy project. The project gives residents a real world experience of serving in the role of health advocate. The projects have produced significant scholarship, including publications and presentations at Regional and National Society of Internal Medicine conferences. A recent cohort’s project on the impact of the Affordable Care Act on individuals with chronic disease was published in the academic journal Annals of Internal Medicine, with an accompanying op-ed in NPR/WBUR’s Commonhealth Blog. Residents identify stakeholders in the community and develop an advocacy plan on how to use their research findings to make change.