Advocacy in Medicine
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Advocacy in Medicine

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A Power-Point presentation on how to train clinicians on the Advocacy Competency.

A Power-Point presentation on how to train clinicians on the Advocacy Competency.

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  • The non-medical expert roles introduce relatively new skill sets for physicians, HA Role relates specifically to the physician’s social responsibility to identify and respond appropriately to the needs of “vulnerable or marginalized” people, Andto attend to “the ethical and professional issues inherent in health advocacy, including altruism, social justice, autonomy, integrity and idealism.”

Advocacy in Medicine Advocacy in Medicine Presentation Transcript

  • Creating Super Physicians Dr Imad S A Hassan MD FACP FRCPI MSc MBBS
  • OUTCOME-BASED MEDICAL TRAINING: HAVING THE END PRODUCT IN 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!
  • What is meant by ADVOCACY? advocacy , championship , upholding , patronage , sponsorship , espousal • • • support (ing) , standing by , advocacy , championship , upholding , patronage , sponsorship • •
  • 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.
  • Health Advocate Role 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 Respond to individual patient health needs and issues as part of patient care
  • Health Advocate Role Respond to individual patient health needs and issues as part of patient care * Biological * Cultural * Social * Financial * Psychological
  • Health Advocate Role Identify opportunities for advocacy, health promotion and disease prevention in the communities & individuals that they serve, and respond appropriately
  • 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 Identify the determinants of health of the populations and individuals, including barriers to access to care and resources; and implement a change
  • 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 Identify vulnerable or marginalized populations within those served and respond appropriately
  • 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 rightsided 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 outpatient 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 COMPETENCIES ITER = IN-TRAINING EVALUATION REPORT OSCE = OBJECTIVE STRUCTURED CLINICAL EXAMINATION SP = 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 +++ + + + + + +