On medical students becoming health advocates

A patient is unable to afford medications necessary to manage their chronic illness. As a physician, you may not even inquire as to whether the patient can afford their prescription medication and thus do nothing OR you may advocate for your patient and for a better healthcare system by ensuring they get their medications and letting healthcare administrators know about this gap in ability to provide care. Which type of physician will you be?

During a Canadian medical student’s training, we become competent in the Can MEDs roles, all 7 of them. One of those roles is that of the Health Advocate. How does medical education and a future physician’s general experience in healthcare teach them to be an advocate and prepare them for contributing to making healthcare better meet patient needs? How do we ensure all “physicians [know their] responsibility [to] use their expertise and influence to advance the health and well-being of individual patients, communities, and populations.”

Well first let me say I think advocates often come from deeply rooted values in justice and equality, but given that, becoming a health advocate can still be a result of teachings or lessons that solidfy this role in a future physician. Altogether, a culture in medicine around advocacy is needed to ensure fair, equitable and accessible care.

Formalizing advocacy work in our education provides a consistent experience. At U of T in pre-clerkship training this consists of lectures on Canada’s healthcare system, examples of physician advocacy and the values of healthcare delivery. Often though, further depth in this requires your own initiative. In some cases, other medical schools provide more opportunities for those wishing to seek it out.

At Boston University, the lack of advocacy training was identified and a program developed to address this gap. Their four-year program helps develop its medical students into proficient health advocates by providing a longitudinal experience combining didactic sessions, mentorship and completion of a self-initiated project. The program typically sees 15% of a class enrol, begins with general theory on the social determinants of health, and then advances into applied experiences of advocacy. Students give back to the program by teaching sessions after they have mastered the content. I believe a program like this helps foster a culture in medicine of physician advocates.

Other means of developing a culture of advocacy in medicine include building leadership around students who are already involved in advocacy work. The University of Toronto has the LEAD program which partially does this. Toronto and other medical schools also often have an active student body involved in their own advocacy work. At Toronto this spans from refugee health to sun safety.

Efforts to foster inter-professional education also serve to advance the health advocate role. Other health professionals are great advocates for their patients, including nurses and social workers. This, I hope, rubs off positively on physician trainees. It does on me, for example when the Canadian Federation for Medical Students this year advocated for a universal pharmacare strategy in Canada, it was largely backed by a policy report from the Canadian Federation of Nurses Unions.

Physician leaders in the public also play a key role by setting an example. Whether it is the Minister of Health and Long-term Care in Ontario advocating for Pharmacare or Physicians standing up for patient’s needs outside of prescription drugs and hospital care. They all inspire us students.

As healthcare transformation progresses in Canada, we will need more physicians who are willing to take on roles as health advocates for individual patients and communities to ensure the best health outcomes for all. Thankfully, within the CanMeds framework, we can establish educational milestones, learn from our peers, colleagues and mentors, and develop as advocates through our own experiential learning. Ultimately, I hope Canada’s future physicians continue to foster a culture of advocacy for the patients and communities they serve.