An evaluation of cascading mentorship as advocacy training in undergraduate medical education

Abstract

Background Physicians are in a position of great influence to advocate for health equity. As such, it is important for physicians-in-training to develop the knowledge and skills necessary to fulfil this role. Although various undergraduate medical programs have implemented health advocacy training, they often lack experiential learning and physician involvement. These aspects are foundational to the Advocacy Mentorship Initiative (AMI) which utilizes cascading mentorship as a novel approach to advocacy training. Medical students develop advocacy competency as peer mentors to youth raised in at-risk environments, while also being mentored themselves by physician residents. We aim to determine whether there are specific advantages to utilizing cascading mentorship to facilitate the attainment of advocacy competencies in undergraduate medical education. Methods Medical students participating in AMI between 2017 to 2020 completed pre- and post-exposure questionnaires. Questionnaires assessed confidence in advocacy-related skills and knowledge of youth advocacy concepts, as well as learning goals, skills gained, benefits of AMI and resident mentors, and impact on future career. Sign tests were utilized to analyze quantitative results, and content analysis was used for open-ended responses. A triangulation protocol was also utilized. Results Fifty mentors participated, 24 (48%) of which completed both pre- and post-exposure questionnaires. Participants gained confidence in advocacy-related skills (p < 0.05) such as working with vulnerable populations and advocating for medical and non-medical needs. They also reported significant improvements (p < 0.01) in their understanding of social determinants of health and concepts related to children’s health and development. Content analysis showed that participants built meaningful relationships with mentees in which they learned about social determinants of health, youth advocacy, and developed various advocacy-related skills. Participants greatly valued mentorship by residents, identifying benefits such as support and advice regarding relations with at-risk youth, and career mentorship. AMI impacted participants’ career trajectories in terms of interest in working with youth, psychiatry, and advocacy. Conclusions AMI offers a unique method of advocacy training through cascading mentorship that engages medical students both as mentors to at-risk youth and mentees to resident physicians. Through cascading mentorship, medical students advance in their advocacy-related skills and understanding of social determinants of health.

The Important Role for Physicians as Advocates for Firearm and Road Traffic Injury Prevention

“…3 The role of the physician as an advocate has been supported by several national and international physician organizations, including the Accreditation Council of Graduate Medical Education in the United States as advocacy has been added to the core competencies. 4 Also, the role of physician responsibility in relation to influences on health has been shown to lie in domains of professional obligation, including individual patient care and addressing socioeconomic influences and access to care. 5 Also more professional aspirations (beyond obligations) may include physicians, along with citizens, having a role in addressing broader health determinants and global health influences.…”

“…Working to join and form strong health coalitions to improve post-crash outcomes, from appropriate and lifesaving measures at the scene of the crash through rehabilitation services. (4). Promoting multidisciplinary research to study the effectiveness of road safety measures, policy interventions, and improvement of post-crash care services.…”

“…For example, the Advocacy Mentoring Initiative (AMI) uses a successful cascading mentoring model to guide hands-on advocacy training for undergraduate medical students where undergraduates serve as peer mentors to at-risk youth, while being mentored by physician residents themselves. 4 Using evidence to inform policy and advocating for equitable resources for vulnerable populations, increasing health coverage, and improving outcomes have long been well-established strategies used by clinical researchers. 18 Physician efforts through medical society affiliation and state healthcare reform, coalition and board leadership, being an advisor to school boards, being healthcare advisors for policy makers, being a health liaison to media, and being an advocate for change in one's own settings are examples of mechanisms for change.…”

Advancing mentorship opportunities of LGBTQ+ youth through a novel cascading mentorship and advocacy training model for medical students

“…Mentors reported significantly increased knowledge in SDOH and child development, as well as increased confidence in working with vulnerable populations and in advocacy skills. 5 AMI's cascading mentorship model can be utilized to enhance undergraduate medical education and bolster understanding of LGBTQ+ health, SDOH, child development, and LGBTQ+ health for medical students, while also providing additional mentorship opportunities for LGBTQ+ youth. Limitations include not knowing the sexual orientation or gender identity of every participant and lack of data concerning specific impacts of the program on the mentees themselves.…”

“…Medical students themselves are mentored by resident physicians, thus creating a cascading mentorship model. 5 The program is overseen by the senior author, a Child and Adolescent and Forensic Psychiatrist.…”