Advocacy in Medicine

Creating Super Physicians

Dr Imad S A Hassan MD FACP FRCPI MSc MBBS

Highly-Skilled, Safe & Competent

Physicians

OUTCOME-BASEDMEDICAL TRAINING:

HAVING THE END PRODUCTIN MIND

What are CanMeds Competencies?

Preparing Future Physicians for the CanMEDS Health Advocate Role:

A work in progress

?

Social Accountability of Clinicians

For well over a decade, there have been persistent requests for

Medical schools to be Socially and community responsive,

and to improve medical education to better prepare future physicians to

Identify and collaboratively address broader determinants of health.

Boelen C, Woollard B. Social accountability and accreditation: a new frontier for educational institutions. Med Educ. 2009;43(9):887-94.

What is meant by ADVOCACY?

Traditional meaning Advocacy means different things to

different people. Its plain English meaning is that

advocacy is supporting another person’s cause or idea.

You r someone

else tongue!

advocacy , championship ,

upholding , patronage ,

sponsorship , espousal

دفاع•تأييد •مناصرة •

support (ing) , standing by , advocacy ,

championship , upholding , patronage

, sponsorship

Dة• مHَوDاَالدDْعJم•

What is meant by ADVOCACY?

Advocacy in Islam

Self-Advocacy Fellow-Muslim Health Advocacy Breastfeeding Advocacy Social Welfare Advocacy Social Justice Advocacy Environmental Health Advocacy Other

Committee of Interns & Residents

What is this Disease?

About a third of all beds in government hospitals are occupied by its victims.

More than 275,000 men, women and children are affected annually

Around 20 of its victims die on a daily basis.

Most of those who die are aged 20-40 years old

KSA Advocacy for Road Safety!

KSA ADVOCACY FOR ROAD SAFETY!According to the Traffic division of the Ministry of Interior in Riyadh, the average annual economic loss related to traffic accidents in Saudi Arabia is estimated at 21 billion Saudi riyals.  That is equivalent to $5.6 billion dollars a year.

On average, 19.1 deaths occur every day and makes the Kingdom’s roads some of the most dangerous in the world.More than 275,000 men, women and children are injured annually

Speeding is the most common cause.

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):972-8.

“vulnerable or marginalized”

“the ethical and professional issues inherent in health advocacy, including altruism, social justice, autonomy, integrity and

idealism.”

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.

1. Respond to individual patient health needs and issues as part of patient care

2. Identify opportunities for advocacy, health promotion and disease prevention in the communities & individuals that they serve, and respond appropriately

3. Identify the determinants of health of the populations and individuals, including barriers to access to care and resources; and implement a change

4. Identify vulnerable or marginalized populations within those served and respond appropriately

Health Advocate Role

Health Advocate Role

Health Advocate Role

Respond to individual patient health needs and issues as part of patient

care

* Biological* Cultural* Social

* Financial* Psychological

Health Advocate Role

Health Advocate Role

Identify opportunities for advocacy, health promotion and disease

prevention in the communities & individuals that they serve, and

respond appropriately

* Screening: Primary Prevention

* Secondary Prevention* Public Interventions

Health Advocate Role

Health Advocate Role

Identify the determinants of health of the populations,

including barriers to access to care and resources; and implement a

change

* Environmental* Political/ Social Justice

* Economic * Ethnic/Genetic

* Cultural/Life-style

Health Advocate Role

Training in Health Advocacy: A Difficult Undertaking

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. 2007 Nov;1(4):363-9.

Oandasan IF. Health advocacy: bringing clarity to educators through the voices of physician health advocates. Acad Med 2005;80(10):S38-41.

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;80:103-8.

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, 2448-51.

Training in Health Advocacy: A Difficult Undertaking

Little research has been conducted on medical educators' perspectives on the role of physician as Health Advocate, and how it can be effectively taught, integrated into medical curricula and subsequent clinical practice, and evaluated.

Case Scenario

A 62 year old poorly-controlled hypertensive (Poor Compliance) female patient presenting with an acute right-sided weakness. Smoked for most of her life. Not on any medications. CT confirmed a left hemispheric infarct.

Case Scenario

The expected Advocacy Actions for this particular case are:

3 5 10 15 More than 20

Case Scenario

The expected Advocacy Actions for this particular case are:

3 5 10 15 More than 20

What are The Expected Advocacy Actions?

Biological Needs Swallowing, Bladder, Bowel Preventive: Aspiration, Bed-sores, DVT Secondary Prevention: Smoking

Cessation, Aspirin

What are The Expected Advocacy Actions?

Biological Needs Specialty Referrals e.g. Stroke Unit,

Physio, Speech Therapy, Social worker, Discharge Planner, Nutritionist, Occupational Therapist etc. to access all available in-patient and out-patient resources etc.

What are The Expected Advocacy Actions?

Economic Needs Financial Support

What are The Expected Advocacy Actions?

Psychological Support/ Psychotherapy Anti-depressants

What are The Expected Advocacy Actions?

Cultural Needs Education on disease, medications,

healthcare resources of Care (rehab, HHC etc)

What are The Expected Advocacy Actions?

Social Needs Home environment Wheelchair Special bed Family Education Access to Healthcare e.g. GP

What are The Expected Advocacy Actions?

Health promotion and disease prevention Screening: Screening for DM,

Dyslipidemia, Osteoporosis, Mammography, Vitamin D Deficiency, Hypothyroidism, Cervical Cancer, Dental Chk, Eye Chk, Colon Ca etc

Vaccinations e.g. Flu, Pneumococcal

What are The Expected Advocacy Actions?

Community Needs Education on Stroke Prevention Stroke Societies membership Ministry of Health Visits/Rotation

What are CanMeds Competencies?

Training on Advocacy Faculty Modelling Lectures Workshops Clinical Activities: Ward Rounds,

Morning Meeting etc Community/Public

Meetings/Conferences Membership of

community/Social/Disease Groups MOH Visits/Rotations

Training on Advocacy

Yes NO

Applying Advocacy

Yes No

Knowledge Translation in Advocacy Use: Translational Education

Training staff in Advocacy is expected to lead to a median improvement of:

10% 30% 50% 70% 100%

Grimshaw J, Thomas RE, Maclennan G, et al.: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004, 8(6):.

Knowledge Translation in Advocacy Use: Translational Education

Training staff in Advocacy is expected to lead to a median improvement of:

10% 30% 50% 70% 100%

Grimshaw J, Thomas RE, Maclennan G, et al.: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004, 8(6):.

KT Principles to Improve Patient Advocacy

Individual/Staff Interventions Education (lectures, leaflets, posters

etc) Clinical Training: Bedside-Training,

Morning Meeting etc Monitoring and Assessment of staff

advocacy activities/actions Organizational Interventions: System

Redesign Checklists, Pathway, Advocacy Team

(Stroke Team)

KEY TOOLS FOR ASSESSING THE CANMEDS COMPETENCIESITER = IN-TRAINING EVALUATION REPORT OSCE = OBJECTIVE STRUCTURED CLINICAL EXAMINATIONSP = STANDARDIZED PATIENT 360°= MULTI-SOURCE FEEDBACK

Medial Expert

Communicator Collaborator Health Advocate

Manager Scholar Professional

Written tests

+++ + + + ++ +++ +

Oral exam +++ + + + + + +

Direct Observation & ITER

+++ +++ +++ + ++ +++ +++

OSCE / SP +++ +++ + + + + +

360° / Peer evaluation

++ ++ +++ ++ ++ + ++

Portfolio ++ + + ++ ++ +++ ++

Simulations +++ + + + + + +

Advocacy