We believe that this study is the first to assess the changes in skills and attitudes of U.S. medical trainees as a result of a single day legislative advocacy experience. Although various physician and medical student organizations offer advocacy experiences, the AMSA Advocacy Day experience was open to all levels of medical trainees and was less limited in scope, as participants were able to select a topic and specific ask to discuss with Congressional offices from a predetermined set of options (healthcare access, student debt reduction, global health funding, and LGBT health equity). Thus, students were able to select an issue that resonated with them and that was aligned with their individual ethical/moral convictions or motivations.
Participants rated their exposure to health policy in formal curricula poorly. This may be attributable to the disproportionate representation of premedical and preclinical students among participants (Table ). Nonetheless, this finding suggests a further need for medical schools to integrate a comprehensive longitudinal health policy curriculum throughout training, including the development of skills in addition to a review of current policy. Interestingly, our results show that the advocacy day experience itself promoted health policy knowledge: following the brief training and advocacy experience, participants indicated an increased knowledge of both PPACA and how health policy can affect the populations they serve (Table ).
Likewise, after engaging in the advocacy day experience, participants were able to identify future opportunities to serve as health advocates (Table ). While our respondents indicated that their health policy curricula are lacking (Table ), our results suggest that advocacy events or projects with a hands-on component can be a valuable component of enhancing policy education. Our survey participants also demonstrated that, in addition to training on the skills and techniques of advocacy, the actual experience of meeting with legislators to discuss policy and communicate positions is an important component of empowering physicians-in-training as future advocates - after the advocacy experience, respondents indicated they felt better able to anticipate the goals and expectations of such a meeting, and felt that they were more prepared to be a physician-advocate (Table ).
Some of the highest Likert scale scores, both from the pre- and post-surveys were those in the attitudes section. Our results continue to support the notion that physicians-in-training view advocacy as an extension of their duty to their patients and their care. While participants initially acknowledged a responsibility to advocate with and for underserved populations, their legislative advocacy experiences reinforced that commitment. Although Likert scale scores reflecting a positive attitude xadvocacytowards advocacy approached the ceiling of the survey, we still found a statistically significant increase following the legislative meetings, indicating that participants believed that the experience was worth the effort. Despite a high baseline, students expressed a significant increase in their plans to engage in health legislative advocacy in the future (Figure ). Notably, the high mean Likert scores for the three statements exclusive to the post-survey indicated that participants had an increased commitment and were likely to engage in advocacy efforts in the future (Table ).
Optional freeform comments provided by participants anecdotally support many of the findings of this study. One participant reported that, “Today was a wonderful opportunity for me to expand my knowledge on health care reform acts currently being reviewed. I had a great experience overall at advocacy and I was inspired to continue advocating!” Another participant described how, “This experience increased my enthusiasm to share my opinion with the legislative community.” One participant described the experience as “amazing,” noting that, “It relates to our future what we do now, and through this visit you get the sense that you're not just going to be a physician but a part of the system that suffers, aides, changes, etc.” Lastly, after experiencing three legislative meetings, one student wrote simply, “The first one was jarring. The second one, exciting. The third one was empowering.”
Our findings represent a small, self-selected sample of physicians-in-training who have opted to participate voluntarily in an advocacy experience limiting the generalizability of our results. Although Advocacy Day was theoretically open to any physician-in-training, advertising for the event was targeted at AMSA members and Convention attendees. As a result, the study sample may not be reflective of the attitudes and opinions of the general premedical or medical student population. While this may affect Likert scores for any specific question, it is less likely that this would impact the differences between paired pre- and post- scores, helping to mitigate any effects of sampling bias in the findings. Some statements had results that approached the ceiling of the survey, making it unlikely that any significant change could be assessed following the advocacy experience. This effect was most notable in the “attitude” category; however, most statements in this category still showed statistically significant changes allowing for analysis and interpretation.
These limitations are common to most studies to date regarding advocacy, largely due to the nascent stage of advocacy education in medicine. As such, our study represents foundational work in the practice and study of healthcare advocacy. While much thought and discussion must continue around the integration of advocacy into medical curricula, we demonstrate that even single experiences can improve the perceived commitment trainees have to advocacy. Further validation of our work is encouraged as the long-term effects of single and longitudinal experiences with advocacy should be assessed. Such longitudinal studies regarding participants’ continued involvement in advocacy activities would be valuable in demonstrating the effectiveness of early advocacy training in producing long-term behavior change and potential patient benefit. Future studies would benefit from increased sample size and advocacy experiences targeted at a broader range of students, ideally in situations in which participation is not optional. Lastly, an evaluation of existing advocacy programs in medical education and their effectiveness would allow for the development of best practices and allow for further dissemination of methods for advancing these valuable skills.