Liberation Medicine: a Community Partnership and Health Advocacy Curriculum for Internal Medicine Residents
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Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA; Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA; 3 Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 4Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA. 2
J Gen Intern Med DOI: 10.1007/s11606-019-05518-1 © Society of General Internal Medicine 2019
INTRODUCTION
Physicians and professional organizations endorse the value of community and legislative health advocacy,1 but community health advocacy training is often neglected in medical training. To address this, in 2000, we implemented a Liberation Medicine (LM) curriculum for Montefiore’s Primary Care/Social Medicine (PC/SM) residents. Defined as the conscious, conscientious use of healthcare to promote social justice and human dignity,2 LM provides a framework to support community efforts to address social arrangements that disproportionately impact health and well-being among poor and marginalized persons. We describe the evolution of our LM curriculum from 2000 to 2017 and present preliminary evaluation results from 2016 to 2017.
METHODS
In 2015, we performed a rigorous exercise to enhance our existing LM curriculum. We invited third-year PC/SM residents who had completed the curriculum to a focus group, then used their feedback to create four curricular aims aligned with ACGME milestones for systems-based practice (Table 1): (1) define and contextualize LM, (2) promote community engagement, (3) foster mentoring relationships with faculty physician advocates, and (4) improve resident advocacy skills. To achieve aim (1), we developed two sessions to introduce LM. To achieve aims (2) and (3), faculty physician advocates and/or leaders of community-based organizations (CBOs) lead/co-lead sessions on local community issues; these sessions also describe strategies for and challenges to successful Received October 7, 2019 Accepted October 22, 2019
partnerships, as well as for career development in community health advocacy. To achieve aim (4), we developed an advocacy writing series for residents to learn about written advocacy, draft and workshop social media posts, and submit advocacy writing to media outlets. Our revised LM curriculum was instituted in 2016. To evaluate our revised LM curriculum, we developed a 20item pre/post survey to assess impact on residents’ confidence in their health advocacy knowledge and skills. Survey items were grouped into four domains: ability to define LM, individual advocacy, community advocacy, and public health advocacy. Residents rated agreement with each item on a 6point Likert scale (1=strongly disagree, 6=strongly agree); survey completion was optional. Results were analyzed continuously using nonparametric paired t tests. We also queried graduating PC/SM residents regarding involvement in health advoc
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