Nana Aisha Garba, MD, PhD, MPH, Florida International University Herbert Wertheim College of Medicine, Miami, FL; Ebony Whisenant, MD, Medical College of Georgia at Augusta University, Augusta, GA; Rachel Clarke, PhD, Florida International University Herbert Wertheim College of Medicine, Miami, FL; Sarah Stumbar, MD, MPH, Florida International University Herbert Wertheim College of Medicine, Miami, FL

Background

In the past decade, the world has responded to different types of public health crises including wars, climate change, and the COVID-19 pandemic. In each case, social determinants of health (SDOH) emerged as key factors impacting the disparate outcomes experienced by individuals and their communities. Although public policies are not considered part of health services infrastructure, they influence health and disease by altering SDOH and are key drivers of health inequities.¹ As a result of their first-hand experience in managing the inadvertent impacts of public policies on both their own practice environment and their patients’ health outcomes,² physicians—particularly those who practice family medicine—can play a significant role in addressing SDOH by raising awareness of health inequities.³ Regrettably, most physicians do not participate in public policy advocacy, partly because they do not know how to get involved, and because of a tradition in medicine that prefers them to remain apolitical.⁴ Recognizing a need to introduce medical students to public policy, a handful of institutions have opted to include this topic in their graduate curricula⁵ instead of the preferred but often time-strapped undergraduate curriculum. Here, we describe a high-yield session designed to demonstrate the value of physician involvement in public policy advocacy to a cohort of graduating fourth-year medical students at Herbert Wertheim College of Medicine (HWCOM), with the ultimate goal of increasing the number of young physicians interested and participating in public policy advocacy.

Methods

The community medicine practicum capstone is the culmination of the community medicine practicum, a longitudinal (4-year) course in which students are required to accrue service-learning hours by volunteering in local underserved communities. The capstone is traditionally a time for graduating students to reflect on their practicum experience and lessons learned during their service activities. To increase students’ awareness of how to get involved in public policy and advocacy work, during the 2021 capstone, we introduced a 2-hour session comprised of  the following steps: (1) a brief presentation on public policy advocacy; (2) video presentations of HWCOM alumni who have engaged in policy work postgraduation describing the activities they are involved in and the impact it has had on their lives, careers, and job satisfaction; (3) a structured, interactive question-and-answer session involving a panel of experienced physicians who have been engaged in different levels of policy work; and (4) an open forum for the graduating students to ask the panelists questions. After the session, the students were asked to complete an optional brief survey to assess the session impact, determine which sections resonated most with them, and obtain their recommendations for future sessions. We completed data analysis using descriptive analysis for quantitative data and content analysis for qualitative data.

Results

A total of 113 students responded to the survey questions, for a 90% response rate. Ninety-seven percent of respondents either strongly agreed or agreed that in the session, they learned about ways to engage in policy advocacy as young physicians. Table 1 shows students’ responses to survey questions assessing the session’s impact. In their open responses describing what they liked most about the session, students used words such as: “inspiring,” “like,” “loved,” “enjoyed,” “role model,” “learning,” “opportunities,” “encouraging,” “valuable,” “grateful,” “unique,” and “understanding.”

Students who provided recommendations for improvements to the session suggested more student involvement in its planning so that it would be more tailored to their specific needs, and providing them with a list of organizations they could work with as residents. Please see Table 2 for some examples of students’ comments.

Conclusion

Based on the enthusiastic student response, a session like this could be a great way to plant the seed of public policy advocacy among graduating medical students, who may have little idea of how to get involved. Furthermore, the brief nature of this session is particularly valuable in a time-limited undergraduate medical curriculum. Students were very receptive and found the session relevant and valuable. Future studies may examine the long-term impacts of this session within the context of our larger medical school curriculum on students’ participation in policy and advocacy work after graduation. Plans for future iterations of this session include supporting students in developing tangible next steps toward participation in public policy advocacy during residency.

Table 1: The Distribution of Students’ Responses to Survey Questions

Table 2: Students’ Responses to Questions Asking What They Liked Most About the Session, and for Recommendations for Future Improvements

References

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2. Moawad H. Here’s how physicians can impact healthcare policies. Medical Economics. July 12, 2017. Accessed June 2, 2021. https://www.medicaleconomics.com/view/heres-how-physicians-can-impact-healthcare-policies
3. Luft LM. The essential role of physician as advocate: how and why we pass it on. Can Med Educ J. 2017;8 (3):e109-e116. Published 2017 Jun 30. doi:10.36834/cmej.36925
4. Kupfer SS, Siddique SM, Proctor DD. Physicians and scientists in gastroenterology as legislative advocates: practical tips and resources. Gastroenterology. 2019;156(4)8:834-7. doi:10.1053/j.gastro.2018.10.058
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