It is time for medical schools to introduce health policy and advocacy education into formal curricula. The Association of American Medical Colleges (AAMC) first called upon physicians to advocate on behalf of their patients in their 1998 report, Learning Objectives for Medical Student Education. Then, in 2002, the American College of Physicians (ACP) released a joint statement with the American Board of Internal Medicine and the European Federation of Internal Medicine, in which they made social justice one of three fundamental principles of medical professionalism.
In 2015, the LCME adopted standards for curricula on advocacy as related to service learning and public health education. And yet, despite this multitude of recommendations, few, if any, formalized programs have successfully equipped medical students with the skills to advocate legislatively. In a 2012 nationwide survey of 13,796 medical students, 40% of students responded that their curriculum was not sufficient in teaching health policy, despite expressing interest in learning skills to communicate with legislators and their staffers.
It’s important to note that advocacy training need not be extensive; even a one-day lobbying event can be sufficient for improving students’ competency. Various medical student organizations have already made political advocacy a part of their mission, especially for students who are underrepresented in medicine. Examples include workshops at conferences or lobbying events such as the Latino Medical Student Association (LMSA) Policy Summit, the Student National Medical Association (SNMA) annual conference, the American Medical Student Association (AMSA) Advocacy Day and more. Clearly, many students desire more advocacy experience, and medical schools have a unique opportunity to help such socially-conscious future clinicians develop their advocacy skills.
There are two main types of advocacy: community-based advocacy — which consists of direct provision of services to marginalized populations — and political advocacy — which involves crafting legislation that affects a large group of people. When practiced effectively, political advocacy can supplement and enhance community-based advocacy. Given the need for more robust advocacy curricula in medical education, this paper establishes the feasibility of building a sustainable and reproducible model for student-led political advocacy. The following case study, as conducted by students at Albany Medical School, introduces a model framework for implementing student-led advocacy education at any medical school.
The Framework and its Outcomes
The proposed framework consists of three phases: learning, teaching and sustainability. First, dedicated medical students should learn about the lobbying process in their community by connecting with knowledgeable community advocates, local legislators, lawyers and patients. Next, these students should engage the wider student body to assess which particular topics students are passionate about, teach them lobbying techniques and encourage them to engage in the advocacy efforts. Lastly, these student leaders should focus on ensuring sustainability by establishing a “lobby day” specific to their medical school which can be repeated annually. Integrating this protocol into medical education could take many forms including dedicated training lectures or establishment of advocacy committees on the school’s student council.
Just such a protocol was met with an overwhelmingly positive response from Albany Medical College (AMC) students as reflected by a 71.42% growth in student participation between 2019 and 2020, in addition to a 122.2% increase in legislator participation. In 2020, there were 35 student attendees who met nine different legislators. Students were split into three groups, each of which spoke with three legislators covering three different topics: funding for Medicaid, medical education and mental health. Participant backgrounds ranged vastly from having extensive knowledge and experience with lobbying to having little to no experience.
Feedback after the session relayed that students were more comfortable speaking with legislators, less intimidated by the prospect of lobbying and more willing to find practical ways to advocate for patients. Students were thankful that opportunities for political advocacy were offered, as they had originally expected that advocacy would be a larger component of their medical education. The following year, the advocacy committee at AMC responded to participant feedback from the inaugural session by engaging students earlier in the year, researching and providing pamphlets about the legislators prior to Lobby Day and holding more frequent meetings leading up to Lobby Day. By engaging participants as early as August, students were afforded more time to research areas for reform and discover their personal passions.
In 2021, the second annual student-led virtual Lobby Day at AMC included 60 student participants who met with 20 legislators to discuss policy measures such as COVID-19 funding and domestic violence awareness, mental health resources, Medicaid funding and environmental conservation. Around 25% of the students had attended the previous year’s Lobby Day. Returning students felt more prepared for the topics and appreciated the addition of legislator researchers (Albany Med students who researched legislators’ profiles to better prioritize the agenda) to the advocacy team.
On Lobby Day, several legislators cosigned bills that the students had researched and endorsed, a particularly encouraging and gratifying outcome for student participants. In subsequent debrief sessions, 10% of students expressed interest in leadership positions for Lobby Day 2022, and 34% of students desired longitudinal relationships with the legislators to ensure that their political advocacy work would continue long after Lobby Day.
Why This is Important for All Medical Students
Albany Med’s location in New York’s capital and the support received by the school’s student council put Albany Medical College at an advantage in forming advocacy initiatives. For schools located further from their respective state capitals or for those that do not have similar support, implementing this framework may be more difficult, but undoubtedly still feasible: for one, such events require only minimal funding, especially when conducted virtually, as the pandemic has necessitated. Furthermore, while some professional faculty may be needed for logistical assistance, the vast majority of the preparation and execution can be achieved by passionate students.
The framework which we developed at AMC teaches students to take the lead in incorporating political advocacy into their medical education; such a holistic education model will help create physicians who not only understand patients’ pathology, but also the social factors which are inseparable from their health. As civic engagement and public recognition of the social determinants of health has become more widespread than ever, it is vital that socially-conscious medical students seize this opportunity to enact lasting political change.
Exposing students at an early stage to the legislative process will create future physicians who will be more civically active throughout their careers and more likely to pass these practices on to subsequent generations. This framework demonstrates the ease and feasibility of establishing sustainable advocacy practices at any medical school; if the passion is present, even physicians-in-training can accomplish concrete policy change.
Image credit: Washington D.C. (CC BY-NC-ND 2.0) by Daniel Mennerich