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Preparing Future Physicians for the CanMEDS Health Advocate Role: A work in progress Medical Education Rounds April 7, 2010  S. Dharamsi & I. Scott ()

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Presentation on theme: "Preparing Future Physicians for the CanMEDS Health Advocate Role: A work in progress Medical Education Rounds April 7, 2010  S. Dharamsi & I. Scott ()"— Presentation transcript:

1 Preparing Future Physicians for the CanMEDS Health Advocate Role: A work in progress Medical Education Rounds April 7, 2010  S. Dharamsi & I. Scott ()  S. Dharamsi & I. Scott (RCPSC Funded Research)  S. Dharamsi & F. Shroff ()  S. Dharamsi & F. Shroff (FDIG)  L. Mu ()  L. Mu (Community Med Resident) Department of Family Practice

2 Requests for community- & social responsiveness Smilkstein G. Designing a curriculum for training community-responsive physicians. J Healthcare Poor Underserved. 1990;1(2): Rubenstein HL, Franklin ED, Zarro VJ. Opportunities and challenges in educating community-responsive physicians. Am J Prev Med. 1997;13(2): Peabody J. Measuring the social responsiveness of medical schools: Setting standards. Acad Med. 1999;74: Brill JR, Ohly S, Stearns MA. Training community-responsive physicians. Acad Med. 2002;77(7):747. Oandasan I, Malik R, Waters I, Lambert-Lanning A. Being community- responsive physicians. Doing the right thing. Can Fam Physician. 2004;50:

3 Social accountability Parboosingh J. Medical schools’ social contract: more than just education and research. Can Med Assoc J. 2003;168(7): Woollard RF. Caring for a common future: medical schools’ social accountability. Med Educ 2006;40: Rourke J. Social accountability in theory and practice. Ann Fam Med. 2006;4(1):S45-8; discussion S Verma S. Honouring the social contract: medical schools take social responsibility seriously. University of Toronto Bulletin (November 14, 2005) Website. Accessed October 16, Boelen C, Woollard B. Social accountability and accreditation: a new frontier for educational institutions. Med Educ. 2009;43(9):

4 Committee on Accreditation of Canadian Medical Schools (CACMS) & Liaison Committee on Medical Education (LCME) “healthcare disparities and the development of solutions to such burdens, the importance of meeting the healthcare needs of medically underserved populations... and [about] core professional attributes, such as altruism and social accountability...”

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6 Health Advocate Role Frank JR, Langer B. Collaboration, communication, management, and advocacy: teaching surgeons new skills through the CanMEDS Project. World J Surg. 2003;27(8): “vulnerable or marginalized” “the ethical and professional issues inherent in health advocacy, including altruism, social justice, autonomy, integrity and idealism.”

7 Health Advocate Role As Health Advocates, physicians responsibly use their expertise and influence to advance the health and well-being of individual patients, communities, and populations. Identify opportunities for advocacy, health promotion and disease prevention in the communities that they serve, and respond appropriately Identify the determinants of health of the populations, including barriers to access to care and resources; and implement a change Identify vulnerable or marginalized populations within those served and respond appropriately

8 Leveridge M, Beiko D, Wilson JW, Siemens DR. Health advocacy training in urology: a Canadian survey on attitudes and experience in residency. Can Urol Assoc J Nov;1(4): Oandasan IF. Health advocacy: bringing clarity to educators through the voices of physician health advocates. Acad Med 2005;80(10):S Verma S, Flynn L, Seguin R. Faculty’s and residents’ perceptions of teaching and evaluating the role of health advocate: a study at one Canadian university. Acad Med 2005;80: Oandasan IF, Barker KK. Educating for advocacy: exploring the source and substance of community-responsive physicians. Acad Med 2003;78(10):S16-9. Herbert CP. The fifth principle. Family physicians as advocates. Can Fam Physician 2001;47:2441-3,

9 Dharamsi & Scott Study Interviews and focus groups To explore Program Directors’ perspectives on the CanMEDS role of the physician as Health Advocate; How the competencies related to health advocacy can best be addressed in residency training.

10 Case Study Your Department has recently had a Royal College review and received accolades for strengths in the Medical Expert Role. However, the Department as been cited for deficiency in the Health Advocate Role (HA). The Residency Program Committee has been gathered to discuss the matter. The Committee has brought in an expert for advice. The expert suggests that efforts to integrate HA into the training program is likely to be more effective if it is undertaken using a participatory approach (i.e., actively involving learners). The Committee is convinced and decides to involve the Urology residents in reviewing the identified weaknesses in the existing curriculum, and to develop a plan to correct them with a focus on the Health Advocate Role.

11 A session with the residents is organized. The expert gives an interactive presentation on the HA role and invites questions at the end. After an awkward silence, one resident says: “Health advocacy is important but we really need to develop proficiency in clinical and surgical skills…the other ‘stuff’ we can figure out later, once we get going in our careers.” Several residents nod in agreement.

12 Faculty Development Initiatives Grant To create an educational primer on Health Advocacy (HA) for post-graduate medical educators Co-Investigator: Dr. Farah Shroff Adjunct Professor in the Department of Family Practice at UBC. Adjunct Professor in the Department of Family Practice at UBC.

13 Health Advocate Role: Key Competencies Physicians are able to… Respond to individual patient health needs and issues as part of patient care; Respond to the health needs of the communities that they serve; Identify the determinants of health of the populations that they serve; Promote the health of individual patients, communities and populations.

14 2. Respond to the health needs of the communities that they serve; 2.1. Describe the practice communities that they serve 2.2. Identify opportunities for advocacy, healthpromotion and disease prevention in the communities that they serve, and respond appropriately 2.3. Appreciate the possibility of competing interests between the communities served and other populations

15 3. Identify the determinants of health for the populations that they serve 3.1. Identify the determinants of health of the populations, including barriers to access to care and resources 3.2. Identify vulnerable or marginalized populations within those served and respond appropriately

16 4. Promote the health of individual patients, communities, and populations 4.1. Describe an approach to implementing a change in a determinant of health of the populations they serve 4.2. Describe how public policy impacts on the health of the populations served 4.3. Identify points of influence in the healthcare system and its structure 4.4. Describe the ethical and professional issues inherent in health advocacy, including altruism, social justice, autonomy, integrity and idealism


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