Tamas Fülöp Award - The network - Towards Unity For Health

INTEGRATING MEDICINE AND PUBLIC HEALTH
Policy and Advocacy Integration
into Training
As we write this article, the resounding
words of one of my Network: TUFH (African)
colleagues is triggered. He asked, “What
do you mean when you say ‘Integration
of Public Health and Medicine’”. As we
proceeded to explain to him the current
movement to integrate the concepts and
principles of public health in undergraduate
and graduate medical curriculum, he
politely stopped us by asking the simple
question “Don’t all doctors do that”. His
question informed us that medicine has
once again come full circle, within a system
of care, to affect population outcomes and
not just individual patients. The simple act
of engaging Family Medicine (FM) residents
in policy and advocacy is a testament of
how we are now revisiting what once was a
norm for healers throughout the world.
Advocacy Efforts
FM residents in the University of New
Mexico’s (UNM) Department of Family and
Community Medicine (DFCM) are engaged
in an effort to affect healthcare outcomes,
not only at the individual level, but at the
community level. The FM residents recently
began their advocacy efforts under the tutelage
of Sally Bachofer and Arthur Kaufman.
Daily, FM residents interact with patients
afflicted with ailments and diseases that
are associated with or triggered by ecological
factors or determinants of health. While
generally, we expect that the residents will
be skilled in treating or positively affecting
the bio-medical aspects of the patient,
we recognise that the residents’ education
is equally fuelled by training to create
change through advocacy and/or policy
development. It is not enough to say that
the patient is non-compliant or is not following
the treatment protocol. We must
also train residents to see what aspects of
the patients’ lives might hinder their ability
to comply with the physicians’ treatment
plan. One approach to engaging the FM
residents in community change is through
an active investigation of current policies.
The policies may be structured within the
framework of an organisation, agency, clinic,
hospital, and/or within the local, state,
or federal Government.
Competencies
The American College of Graduate Medical
Education has restructured the paradigm
of residency education to focus on competencies
and outcomes (www.acgme.org/
outcome/comp/GeneralCompetenciesStan
dards21307.pdf, retrieved June 10, 2008).
The Systems Based Practice competency
includes two elements that apply to advocacy
and policy development: “participate in
identifying system errors and implementing
potential system solutions”, and “advocate
for quality patient care and optimal patient
care systems”. The UNM residents have
been involved in several initiatives to gain
skills and knowledge aimed at fulfilling
these competencies. Residents may elect
to incorporate the Department of Family
and Community Medicine’s Public Health
Certificate programme into their curriculum.
Residents are involved directly in policy
and advocacy activities during their clinical
experiences, both in the hospital and
through their continuity clinics. A couple of
policy and advocacy projects in which the
residents were engaged are outlined below.
Projects
Expanded Pharmacy Hours
Patients were frequently admitted to the hospital
because their access to medications was
limited by restricted hours of the University
Pharmacy. After meeting with the pharmacy
staff and investigating other indigent pharmacy
systems, the residents presented a
report to the administration that resulted in
the expansion of pharmacy hours.
Advocacy for Expanded Social Services
Delayed discharges and subsequent overcrowding
of the emergency department
We must also
train residents
to see what
aspects of the
patients’ lives
might hinder
their ability to
comply with
the physicians’
treatment plan.
has a broad impact on hospital function.
By gathering data and learning about the
pertinent management issues, residents
were able to develop a collaborative effort
with the Social Services Department, which
resulted in the recommendation to allocate
funding to new social worker positions
which would help alleviate this situation.
Conclusion
The far-reaching impact of resident involvement
in advocacy and policy extends beyond
the individual patient or the focused clinical
experience. The population of people whose
healthcare options are negatively impacted
by a particular policy may now be positively
affected at new levels by physicians. At
the academic level, residents who engage
in policy development and advocacy, role
model their behaviour for medical students
to emulate. Physicians are empowered to
liberate themselves from the confines of the
office and impact policy that may contribute
to the well being of not only their patients,
but large populations at one time.
Sally Bachofer, Lily Velarde, Vanessa
Jacobsohn, Amy Clithero, Arthur Kaufman
| Department of Family and Community
Medicine, School of Medicine, University
of New Mexico, USA
Email: livelarde@salud.unm.edu
J U L Y 2 0 0 8
N E W S L E T T E R N U M B E R 0 1 | V O L U M E 2 7
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