De Sutter, An

Decat, Peter

Demirören, Meral

European Journal of General Practice

English

DEMİRÖREN, MERAL

Hacettepe  University Reserach Information System

Teaching the health advocacy role in family medicine: Trial and error

Hacettepe University Institutional Repository

Teaching the health advocacy role in family medicine

Ghent University Academic Bibliography

Full Terms & Conditions of access and use can be found athttps://www.tandfonline.com/action/journalInformation?journalCode=igen20European Journal of General PracticeISSN: 1381-4788 (Print) 1751-1402 (Online) Journal homepage: https://www.tandfonline.com/loi/igen20Teaching the health advocacy role in familymedicine: Trial and errorPeter Decat, Meral Demirören & An De SutterTo cite this article: Peter Decat, Meral Demirören & An De Sutter (2019) Teaching the healthadvocacy role in family medicine: Trial and error, European Journal of General Practice, 25:4,177-178, DOI: 10.1080/13814788.2019.1674048To link to this article:  https://doi.org/10.1080/13814788.2019.1674048© 2019 The Author(s). Published by InformaUK Limited, trading as Taylor & FrancisGroup.Published online: 16 Oct 2019.Submit your article to this journal Article views: 337View related articles View Crossmark dataEDITORIALTeaching the health advocacy role in family medicine: Trial and errorSeptember, the start of the postgraduate training atthe faculty of medicine. Traditionally, two topics domin-ate the introduction for students in family medicine: thewarm days of the inevitable Indian summer and theseven canmeds roles that describe the abilities physiciansshould have to meet the health care needs of patients.As experienced lecturers, we do not hesitate in tellingthe students in detail how to act as medical expert, com-municator, collaborator, scholar, manager or professional.However, there is one of the roles that we keep for theend, hoping to be saved by the bell, or that we, acciden-tally or intentionally, forget: the family physician as ahealth advocate. The role of health advocacy is seen asone of the most challenging roles to teach and evaluate[1]. Poulton and Rose identified three key barriers affect-ing health advocacy education: a lack of clarity of theconcept, insufficient experience in how to put healthadvocacy learning in practice and nonexistence of astandard for assessment [2].First, there is a need for a good definition of the con-cept. Is the health advocacy role limited to the inter-action between the physician and the individual patient?Or does it also entail an engagement beyond the prac-tice walls? We believe that family doctors should betrained in the preparedness and skills to promote healthat individual, community and policy level [3]. Recently,the Centre of Family Medicine University Ghent added totheir mission statement that they have a particular inter-est for the social accountability of family doctors as acti-vists for universal access to health care and as signallersof social injustice and exclusion. This is in line with themodified definition of the health advocate role withinthe CanMeds framework that states: ‘physicians contrib-ute their expertise and influence as they work with com-munities or patient populations to improve health. Theywork with those they serve to determine and understandneeds, speak on behalf of others when required, and sup-port the mobilization of resources to effect change’ [4].But how to teach this? Although, difficult and with lit-tle agreement on how it should be done, we developedat our university a programme to make students moreaware of their future health advocacy role. The aim is tointroduce them directly to clinical and nonclinical set-tings that work for and with vulnerable populations. Inthis way, students, often themselves belonging to ahigher socio-economic class, are exposed to inequity,poverty and ill-making contexts and find out how asfuture family doctors they may contribute positively tothe health of individuals and communities in cooperationwith other professionals, welfare organisations, volunteersand patients. This exposure happens through participa-tion in various local initiatives supported by the city gov-ernance, community health centres or welfareorganisations. Here, we will briefly present some exam-ples. A first example is a pilot project with communityhealth workers, funded by the city council. The initiativeaimed to bridge the gap between disadvantaged groupsand the official healthcare system. Medical studentsactively participated in the training of community healthworkers and others were involved in the evaluation ofthe project. In another project, students collaboratedwith teachers of primary schools in deprived areas forlessons on mental health and nutrition. In a third project,a card play was designed and tested to be used as a toolto discuss sexual rights among young migrant women.Further, a group of students conducted focus group dis-cussions and interviews with community members toexplore the accessibility of health care services in thecity. Again, others participated in various community-based activities promoting sexual health, healthy feeding,mental health or physical exercise.The communities and the students highly appreciatethese practical experiences. Students recognise that thisexposure contributes to their awareness of the needs ofthis vulnerable population. Besides, it brings them in con-tact with role models in health care and welfare thatshape their perspectives. The feeling of making a differ-ence makes them feel fulfilled and creates motivation toprovide responsive care to the needs of communitiesand individuals. Finally, it contributes positively to theimage of family doctors as advocates of health in andwith the community.Place-based learning through participation at health-promoting and aware making activities contributes tostudents competences to respond to health needs at theindividual and community level. However, there is stillthe policy part of the health advocacy role. As familyphysicians, we operate from within the society and arewell placed to bring health issues at the political level.We do not plead to include policy training in the stand-ard package for all postgraduates in family medicine.However, some students have the interest and the per-sonal characteristics to act at the political level. Thesestudents need to be identified and to be supported intheir development as change-makers.Finally, standards for evaluating the health advocacyrole are lacking. There is a need for tools that measurethe impact of training. And what aspects should beEUROPEAN JOURNAL OF GENERAL PRACTICE2019, VOL. 25, NO. 4, 177–178https://doi.org/10.1080/13814788.2019.1674048tested? Knowledge on social determinants and the readi-ness to integrate the advocacy role in professional prac-tice are fundamental [5,6]. Therefore, Belgian and Turkishmedical institutes will develop and assess an instrumentto scale this knowledge and motivation among med-ical students.As medical institutes, we have the mission to deliversocial accountable physicians. Future family physicianswho will work with and in communities, should be pre-pared to advocate health at individual, community andpolitical level. There are no standards on how this can betaught. It is a matter of trial and error. To our experienceplace-based learning is an excellent mechanism to shapeawareness and motivation among students. In a nextstep, we will try out strategies for the evaluation of thehealth advocacy role and for the support of students andphysicians who feel called upon to voice health needs atthe policy level.Disclosure statementThe authors report no conflict of interest. The authors aloneare responsible for the content and writing of the paper.ORCIDPeter Decat http://orcid.org/0000-0001-8948-6040Meral Demir€oren http://orcid.org/0000-0001-7415-9602An De Sutter http://orcid.org/0000-0002-2540-8307References[1] Dobson S, Voyer S, Regehr G. Perspective: agency and activ-ism: rethinking health advocacy in the medical profession.Acad Med. 2012;87(9):1161–1164.[2] Poulton A, Rose H. The importance of health advocacy inCanadian postgraduate medical education: current attitudesand issues. Can Med Educ J. 2015;6(2):e54–e60.[3] Dobson S, Voyer S, Hubinette M, et al. From the clinic to thecommunity: the activities and abilities of effective healthadvocates. Acad Med. 2015;90(2):214–220.[4] Frank J, Snell L, Sherbino J. Physician competency frame-work. Ottawa: Royal College of Physicians and Surgeons ofCanada; 2015 [cited 2015 Sept 26]. Available from: https://www.slideshare.net/ssnyman2/canmeds-2015-frameworkenre-duced-final[5] Hubinette M, Dobson S, Scott I, et al. Health advocacy. MedTeach. 2017;39(2):128–135.[6] Pelaccia T, Viau R. Motivation in medical education. MedTeach. 2017;39(2):136–140.Peter DecatDepartment of Public Health and Primary Care, Faculty ofMedicine and Health Sciences, Ghent University, Ghent,BelgiumPeter.Decat@UGent.beMeral Demir€orenDepartment of Medical Education and Informatics,Hacettepe University Faculty of Medicine, Ankara, TurkeyAn De SutterDepartment of Public Health and Primary Care, Faculty ofMedicine and Health Sciences, Ghent University, Ghent,Belgium 2019 The Author(s). Published by Informa UK Limited, trading asTaylor & Francis Group.This is an Open Access article distributed under the terms of theCreative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work isproperly cited.178 EDITORIAL

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Teaching the health advocacy role in family medicine: Trial and error

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