Over the past century, health professions education has undergone major reforms in response to the dynamic changing landscape of health care. From Flexnerian reforms to competency-based education, changes have been catalyzed by an evolving understanding of disease, technological advancements, and shifting healthcare paradigms. As we navigate contemporary healthcare complexities and health disparities across the globe, the imperative for progressive and responsive educational frameworks has become increasingly pronounced.

Looking at the health systems framework it has become critical for education and health systems to work together. Health systems science, health humanities, and diversity, equity and inclusion are becoming core components of medical education. Changes in healthcare have also led to an emphasis on leadership development in healthcare professionals. These changes have been brought about by factors such as improvements in information technology, advances in precision medicine, community involvement, provision of services during periods of financial instability, and more recently the global COVID-19 pandemic. As a result, our future healthcare professionals need to learn to advocate for their patients, be self-aware, and prioritize personal and professional growth. Frameworks such as CanMEDS have set out definitions of healthcare advocacy and leadership teaching, but presently there is no defined national health advocacy framework within graduate medical education in the United States. This is a gap in our system. It would be helpful to introduce the concept of advocacy leadership into the medical education curricula more broadly.

In the current environment of rapid health care transformations and growing influence of politics over medicine, physicians have an obligation to be health care advocates, lobby for health equity, and help change government policies. The Accreditation Council of Graduate Medical Education (ACGME) review committee for Internal Medicine has emphasized advocacy and leadership as necessary skills in preparing the future generation of internists. There are multiple formal advocacy and leadership curricula reported in the United States and Canada to train socially responsible medical learners.

Health advocacy is defined as purposeful actions to address determinants of health that negatively affect individuals or communities either by informing those who can enact change by initializing, mobilizing, and organizing activities to make change happen, with or on behalf of communities they work with. This includes working at the community, state, and federal levels, establishing strong, longitudinal community partnerships, influencing health policy, and creating new programs.

Health systems science - now considered to be the third pillar of medical education - is the study of how health care is delivered, how health care professionals work together to deliver that care and how the health care system can improve patient care and health care delivery. Advocating for patients has become an important part of providing optimal health care delivery. A curriculum to train students to actively apply their knowledge and skills in health equity, patient and health advocacy, develop self-awareness and self-reflection, prioritize leadership and communication skills may have the trickle-down effect of improving patient care. The curriculum would also need to teach students the practicalities and barriers to identifying and addressing health inequities to enable them to advocate for change. The health advocate role is a vital pillar of the CanMEDs competency framework, requiring future physicians to develop key capabilities that would enable them to address the social determinants of health and improve health outcomes at the level of patient, the community and the population served. This model can be used as an example.

Effective integration of the concept of health advocacy into medical education still remains a challenge. What could the possible reasons be? Some scholars believe that it is the lack of socioeconomic diversity in the medical school class demographic profile. Others feel that medical education offers limited opportunities to work with socially disadvantaged and marginalized groups, which is required to gain the knowledge and skills necessary to be an effective health advocate.

Public health advocacy is increasingly acknowledged as an essential component of medical practice that should be prioritized by medical schools, residency programs and professional organizations. Advocacy can range from small scale efforts, such as the advocacy role a parent may play in the care of their child, to large scale ones such as the lobbying and organizational methods employed by patient advocacy associations and groups. Patient advocacy has always held a place in medical practice, although it has taken many shapes over the years. Now is the time to explicitly and intentionally integrate advocacy leadership training into all our health professions curricula.

Did you know that the Harvard Macy Institute Community Blog has had more than 385 posts? Previous blog posts have explored topics including teaching about health equity and advocacy, bedside teaching, and inclusive health professions education.

Vinita J Acharya

Vinita J. Acharya, MD, FAAN, FANA, FAES (Educators ’21, TTVE ‘21, Leaders ’23) is an Associate Professor of Neurology and a Distinguished Educator at Penn State University. Her areas of professional interest include health systems education, population health, and advocacy leadership. Vinita can be followed on LinkedIn or contacted via email