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

1. Creating Super Physicians
Dr Imad S A Hassan MD FACP FRCPI MSc MBBS

2. OUTCOME-BASED
MEDICAL TRAINING:
HAVING THE END PRODUCT
IN MIND

3. What are CanMeds
Competencies?

4. Preparing Future Physicians for the
CanMEDS Health Advocate Role:
A work in progress
?

5. 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.

6. 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!

7. What is meant by
ADVOCACY?
advocacy ,
championship ,
upholding , patronage
, sponsorship ,
espousal
•
•
•
support (ing) ,
standing by ,
advocacy ,
championship ,
upholding , patronage
, sponsorship
•
•

8. Advocacy in Islam







Self-Advocacy
Fellow-Muslim Health Advocacy
Breastfeeding Advocacy
Social Welfare Advocacy
Social Justice Advocacy
Environmental Health Advocacy
Other

10. Committee of Interns &
Residents

11. 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

12. KSA Advocacy for Road
Safety!

13. 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.

14. 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.”

15. 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.

16. 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

17. Health Advocate Role
Respond to individual patient health needs
and issues as part of patient care

18. Health Advocate Role
Respond to individual
patient health needs and
issues as part of patient care
* Biological
* Cultural
* Social
* Financial
* Psychological

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

20. 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

21. 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

22. 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

23. Health Advocate Role
Identify vulnerable or marginalized
populations within those served and
respond appropriately

24. 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.

25. 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.

26. 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.

27. Case Scenario

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The expected Advocacy Actions for this
particular case are:
3
5
10
15
More than 20

28. Case Scenario

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
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The expected Advocacy Actions for this
particular case are:
3
5
10
15
More than 20

29. What are The Expected
Advocacy Actions?

Biological Needs



Swallowing, Bladder, Bowel
Preventive: Aspiration, Bed-sores, DVT
Secondary Prevention: Smoking Cessation,
Aspirin

30. 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.

31. What are The Expected
Advocacy Actions?

Economic Needs

Financial Support

32. What are The Expected
Advocacy Actions?



Psychological Support/
Psychotherapy
Anti-depressants

33. What are The Expected
Advocacy Actions?

Cultural Needs

Education on disease, medications, healthcare
resources of Care (rehab, HHC etc)

34. What are The Expected
Advocacy Actions?

Social Needs

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
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Home environment
Wheelchair
Special bed
Family Education
Access to Healthcare e.g. GP

35. 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

36. What are The Expected
Advocacy Actions?

Community Needs

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Education on Stroke
Prevention
Stroke Societies membership
Ministry of Health Visits/Rotation

37. What are CanMeds
Competencies?

38. Training on Advocacy
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Faculty Modelling
Lectures
Workshops
Clinical Activities: Ward Rounds, Morning
Meeting etc
Community/Public Meetings/Conferences
Membership of community/Social/Disease
Groups
MOH Visits/Rotations

39. Training on Advocacy

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Yes
NO

40. Applying Advocacy


Yes
No

41. 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):.

42. 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):.

43. KT Principles to Improve
Patient Advocacy

Individual/Staff Interventions
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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)

44. 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
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Oral exam
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Direct
Observation
& ITER
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OSCE / SP
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360 / Peer
evaluation
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Portfolio
++
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Simulations
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