A is for advocacy: How introducing student advocacy assessment impacts longitudinal integrated clerkship students and clinical supervisors

Ziv, Tali; Wamsley, Maria; Lai, Cindy J.; Griffiths, Elizabeth P.; Maxey, Alexandra; Kryzhanovskaya, Irina

doi:10.1080/0142159x.2021.1967903

Cited by 6 publications

(2 citation statements)

References 26 publications

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“…40,41 Adams and colleagues have described how the CUSOM LIC aids development of an "equity identity, " which involves advocating for underserved populations, 17 while Ziv and colleagues highlight that LIC students develop as advocates through "lifting patient voices and connecting. " 42 Our study reinforces these findings-constructing an identity as a patient advocate through longitudinal connection with patients was a transformative experience across contexts and shaped students' understanding of their future role. Empowered by their familiarity with the ways of working within the community of practice (or practices) they were learning within, students constructed advocacy identities through participation in patient care.…”

Section: Discussionsupporting

confidence: 81%

Medical Student Identity Construction Within Longitudinal Integrated Clerkships: An International, Longitudinal Qualitative Study

Brown¹,

Ard²,

Adams³

et al. 2022

Academic Medicine

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Purpose Longitudinal integrated clerkships (LICs) have been implemented worldwide to increase authentic student participation in patient care over time. Studies have shown benefits of the model include the ability of LICs to attract future practitioners to underserved areas, student engagement in advocacy, and development of an “ethic of caring.” Less is known, however, about how LICs impart their benefits, although LICs may strengthen professional identity. As such, this study aimed to explore medical student professional identity construction through time within LICs internationally. Method This was a longitudinal qualitative study from 2019 to 2020, involving 33 students across 4 medical schools in the United Kingdom, Ireland, and the United States. The authors explored participating students’ identity construction during LICs. Data collection involved 3 stages: individual, semistructured interviews at entry (n = 33) and exit of the LIC (n = 29), and audio diaries throughout. Data were analyzed inductively using a reflexive thematic approach. Results Three themes were identified. Longitudinal relationships with patients and preceptors encouraged patient care ownership and responsibility; LIC students identified as patient advocates; and longitudinal relationships shaped students’ social consciences. Themes were underpinned by continuity of relationships between students and patients, and students and tutors. Conclusions Though continuity is lauded as the cornerstone of LICs, these findings suggest that this is too broad a way of understanding the benefits of LICs. Instead, continuity should be seen as facilitating the development of important relationships within diverse communities of practice, which leads medical students to construct professional identities as responsible, compassionate advocates for underserved populations. This was the case across the institutions, nations, and LIC types in this study. By highlighting the ways in which LICs influence identity, these findings offer important insight relating to the future development and delivery of LICs.

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Section: Discussionsupporting

confidence: 81%

Medical Student Identity Construction Within Longitudinal Integrated Clerkships: An International, Longitudinal Qualitative Study

Brown¹,

Ard²,

Adams³

et al. 2022

Academic Medicine

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“…This presents a difficulty in practitioners’ ability to serve as role models for students [ 14 ]. Because the theme of HP is still less pronounced than other curriculum themes and is often poorly defined in terms of assessment, this leads to students attaching less importance to it [ 14 15 16 17 ]. Due to these challenges, existing literature on workplace-based learning offers limited guidance for designing workplace-based learning focused on HP.…”

Section: Introductionmentioning

confidence: 99%

Designing a Workplace-Based Learning Environment for Learning Health Promotion: A Design-Based Research

Verhees,

Landstra,

Engbers

et al. 2024

Perspect Med Educ

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Introduction: The healthcare landscape has a growing emphasis on health promotion (HP), which makes HP important in the training of future physicians. This study employed design-based research to develop a clerkship focused on HP and to outline design principles for shaping workplace learning environments to promote HP learning. Methods: We evaluated a nursing-home clerkship designed at Radboud University Medical Center in the Netherlands, and refined it over three rounds. Data collection involved individual and group interviews with students and supervisors, as well as observations during clerkship-related meetings and activities. These interactions also facilitated the exchange of perspectives between participants and generation of new design ideas, fostering co-creation of the clerkship design. Data were analyzed through iterative thematic inquiry to inform new design choices and develop design principles. Results: Evolved clerkship designs included an app for capturing practice experiences to discuss in relation to students’ professional roles, loosening the strict assessment structure, and collaborative creation of a practice assignment about ‘Positive Health’. We constructed four design principles, including: to question and discuss students’ professional identity, provide concrete and meaningful assignments, aim for a peer-learner role for supervisors, and foster co-creation of the workplace learning environment. Discussion: Our design principles support the design of workplace-based learning for HP, a subject that is novel within healthcare practice. We find that co-creation of workplace-based learning, which requires embracing uncertainty, is pivotal in this context, for students, practitioners, and educational institutions.

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Patient Advocacy Assessment in the Medicine Clerkship: A Qualitative Study of Definition, Context, and Impact

et al. 2022

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Background Advocacy is a core value of the medical profession. However, patient advocacy (advocacy) is not uniformly assessed and there are no studies of the behaviors clinical supervisors consider when assessing advocacy. Objective To explore how medical students and supervisors characterize advocacy during an internal medicine clerkship, how assessment of advocacy impacted students and supervisors, and elements that support effective implementation of advocacy assessment. Design A constructivist qualitative paradigm was used to understand advocacy assessment from the perspectives of students and supervisors. Participants Medical students who completed the internal medicine clerkship at UCSF during the 2018 and 2019 academic years and supervisors who evaluated students during this period. Approach Supervisor comments from an advocacy assessment item in the medicine clerkship and transcripts of focus groups were used to explore which behaviors students and supervisors deem to be advocacy. Separate focus groups with both students and supervisors examined the impact that advocacy assessment had on students’ and supervisors’ perceptions of advocacy and what additional context was necessary to effectively implement advocacy assessment. Key Results Students and supervisors define advocacy as identifying and addressing social determinants of health, recognizing and addressing patient wishes and concerns, navigating the health care system, conducting appropriate evaluation and treatment, and creating exceptional therapeutic alliances. Effective implementation of advocacy assessment requires the creation of non-hierarchical team environments, supervisor role modeling, and pairing assessment with teaching of advocacy skills. Inclusion of advocacy assessment reflects and dictates institutional priorities, shapes professional identity formation, and enhances advocacy skill development for students and their supervisors. Conclusions Students and supervisors consider advocacy to be a variety of behaviors beyond identifying and addressing social determinants of health. Effectively implementing advocacy assessment shapes students’ professional identity formation, underscoring the critical importance of formally focusing on this competency in the health professions education.

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A is for advocacy: How introducing student advocacy assessment impacts longitudinal integrated clerkship students and clinical supervisors

Cited by 6 publications

References 26 publications

Medical Student Identity Construction Within Longitudinal Integrated Clerkships: An International, Longitudinal Qualitative Study

Medical Student Identity Construction Within Longitudinal Integrated Clerkships: An International, Longitudinal Qualitative Study

Designing a Workplace-Based Learning Environment for Learning Health Promotion: A Design-Based Research

Patient Advocacy Assessment in the Medicine Clerkship: A Qualitative Study of Definition, Context, and Impact

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