How Are We Teaching Advocacy? A National Survey of Internal Medicine Residency Program Directors

Joel R Burnett; Bryanna De Lima; Emily S Wang; Kelly McGarry; Daniel I Kim; Michael Kisielewski; Kelsi Manley; Sima S Desai; Elizabeth Eckstrom; Tracey L Henry

doi:10.1007/s11606-024-08753-3

How Are We Teaching Advocacy? A National Survey of Internal Medicine Residency Program Directors

J Gen Intern Med. 2024 May 6. doi: 10.1007/s11606-024-08753-3. Online ahead of print.

Authors

Affiliations

¹ Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA. joel.burnett.md@gmail.com.
² Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA.
³ UT Health San Antonio Long School of Medicine, San Antonio, TX, USA.
⁴ Alpert Medical School at Brown University, Providence, RI, USA.
⁵ University of California, Riverside School of Medicine, Riverside, CA, USA.
⁶ Alliance for Academic Internal Medicine, Alexandria, VA, USA.
⁷ Emory University School of Medicine, Atlanta, GA, USA.

PMID: 38710862
DOI: 10.1007/s11606-024-08753-3

Abstract

Background: Although internal medicine (IM) physicians accept public advocacy as a professional responsibility, there is little evidence that IM training programs teach advocacy skills. The prevalence and characteristics of public advocacy curricula in US IM residency programs are unknown.

Objectives: To describe the prevalence and characteristics of curricula in US IM residencies addressing public advocacy for communities and populations; to describe barriers to the provision of such curricula.

Design: Nationally representative, web-based, cross-sectional survey of IM residency program directors with membership in an academic professional association.

Participants: A total of 276 IM residency program directors (61%) responded between August and December 2022.

Main measurements: Percentage of US IM residency programs that teach advocacy curricula; characteristics of advocacy curricula; perceptions of barriers to teaching advocacy.

Key results: More than half of respondents reported that their programs offer no advocacy curricula (148/276, 53.6%). Ninety-five programs (95/276, 34.4%) reported required advocacy curricula; 33 programs (33/276, 12%) provided curricula as elective only. The content, structure, and teaching methods of advocacy curricula in IM programs were heterogeneous; experiential learning in required curricula was low (23/95, 24.2%) compared to that in elective curricula (51/65, 78.5%). The most highly reported barriers to implementing or improving upon advocacy curricula (multiple responses allowed) were lack of faculty expertise in advocacy (200/276, 72%), inadequate faculty time (190/276, 69%), and limited curricular flexibility (148/276, 54%).

Conclusion: Over half of US IM residency programs offer no formal training in public advocacy skills and many reported lack of faculty expertise in public advocacy as a barrier. These findings suggest many IM residents are not taught how to advocate for communities and populations. Further, less than one-quarter of required curricula in public advocacy involves experiential learning.

Keywords: curriculum; graduate medical education; physician advocacy; professionalism; survey study.