Advocacy & Health Policy Curriculum Development
A Toolkit for Family Medicine Residency Programs
Authors: Julie N. Thai, MD, MPH; Hussein Saghir, DO, MPH; Paul Lazar, MD; Prabhat Pokhrel, MD, MS, PhD
Advocacy is believed to be inherent within the specialty of family medicine, but the tools and resources to advocate for and effect change in healthcare at the policy level are not readily accessible, especially in resource-limited communities.
An Advocacy and Health Policy Curriculum would help empower family medicine resident trainees (some of whom may go on to become faculty) to advocate on behalf of the patients they serve in both a clinical and social context.
This toolkit, developed at McLaren Flint Family Medicine Residency in Flint, MI, is intended to serve as a guide that can be replicated and modified by other residency programs.
The U.S. healthcare system is constantly in flux with complicated health policy changes being made by non-physicians and those who are not intimately involved with healthcare delivery and its intrinsic challenges. As a result, policy changes may not serve patients and physicians well. Inherent in family medicine is the role of the physician as advocate.
The American Academy of Family Physicians (AAFP) serves as the professional organization that represents more than 136,000 family physicians across the country.1 The AAFP also serves as a platform for advocacy within the field, allowing for medical students and residents to participate in advocacy and health policy work at the National Congress of Family Medicine Residents and National Congress of Student Members, which convene annually.1
In recent years, there have been increasingly more workshop offerings on advocacy and health policy topics at national meetings for primary care providers.2 However, despite the amount of advocacy work that is being done through AAFP and its state chapters and the American Medical Association, advocacy and health policy training in family medicine residency is currently not a competency required by the Accreditation Council for Graduate Medical Education.
Efforts have recently increased for making advocacy and health policy training more accessible to the healthcare workforce, especially in internal medicine and for medical students.2,3,4,5 For example, the Society of General Internal Medicine launched its one-year health policy career development program, Leaders in Health Policy, in 2017, creating an opportunity for clinician educators to become leaders in health policy efforts.2
At the medical student training level, the University of Colorado Denver School of Medicine created the LEADS (Leadership Education Advocacy Development Scholarship) Program to train students to become advocates and health policy leaders.3
ACGME requirements indicate that “residents must learn to advocate for patients within the healthcare system to achieve the patient's and family's care goals, including, when appropriate, end-of-life goals.” In 2020, AGGME requirements included advocacy milestones for family medicine residents as part of its Systems-Based Practice competency for trainees. Under “Advocacy,” there are five levels of competency, from identifying “that advocating for patient populations is a professional responsibility” (level 1) to developing “a relationship with stakeholders that advances or prevents a policy change that improves individual or community health” (level 5).6
Forming a Task Force
The task force should:
- Be inclusive of primary stakeholders, such as residents, faculty, AAFP state chapter members, especially the legislative liaison if one exists, and other key individuals who will help inform the curriculum development and assist with communications and relationship-building between residents and legislators.
- Meet regularly to discuss the curriculum content and gather resources at the local, state, and national levels to help develop a robust curriculum for trainees.
- Decide if the curriculum will be 1) a four-week elective offered either during an elective month or during a Health Systems Sciences or similar rotation; 2) a longitudinal curriculum spanning the duration of the three-year family medicine residency training; or 3) a hybrid of both options, depending on the program's curriculum.
Identifying a Mentor
The mentor should be a stakeholder (e.g., faculty member, hospital administrator, legislative liaison, or local, state or national legislator) who is willing and available to help the resident identify a policy challenge and viable solutions. Ideally, the mentor will help the resident complete the capstone project, which is a required component of the Advocacy and Health Policy Curriculum.
Role of the Residency Program Director and Other Faculty
The residency program director and other faculty should be available to mentor the resident and ensure that the objectives of the curriculum are being met. For instance, the director and/or other faculty may decide to meet with the resident on a weekly basis to monitor progress and help troubleshoot any problems or conflicts that arise.
The Advocacy and Health Policy Curriculum should comprise engagement activities and a capstone project that includes policy analysis to teach residents the skills necessary for advocating in support of policies benefiting patients and preserving the integrity of the practice of medicine.
Curriculum objectives should help residents meet the five levels of the advocacy milestones.
- Residents should be able to work with stakeholders to advance or prevent a policy change that will benefit individual and/or population health (can be achieved through the required capstone project, which serves as the core of the rotation).
- Residents should know how to access advocacy tools and resources to effect policy change.
- Residents should be able to identify stakeholders and how their respective roles in influencing and affecting health policy on multiple levels, including the local, state, and national levels.
- Residents should be able to describe the impact of a particular policy on the health of a population.
- Residents should be able to prepare resolutions and may choose to submit one to a family medicine advocacy forum.
- Residents should be able to give input (either in person, by email, or through AAFP Speak Out) to a local, state, or national legislator about a policy challenge.
- Residents should be able to identify at least one policy challenge that affects their patients and/or practice and develop potential policy options that would address these challenges in a practical manner.
- Residents should be able to outline the process for how healthcare policy or law is made.
The Advocacy and Health Policy Curriculum's capstone project is the core of the rotation and a required experience intended to tie together what the resident has learned through the four-week or longitudinal curriculum. It is an opportunity for the resident to apply advocacy and health policy skills.
Steps for the capstone project:
- Resident discusses several issues with the mentor that are major problems for their patients and/or their practice.
- Resources are available to the resident to help in gathering basic information about the problems, the current relevant facts (e.g., health statistics), and how the problems are impacted by current policy.
- Resident reviews what they have learned and gathered with their mentor and chooses one issue that is feasible to address with policy change.
- Resident engages with stakeholders (e.g., patients, hospital leadership, other family medicine trainees, AAFP state chapter leadership and members) to collect information about how to improve the current policy, develop new policy, or eliminate current policy if it has deleterious effects on individual or population health. Examples of engagement activities
- The capstone project is complete when the resident has discussed the policy options with their mentor, written a policy analysis paper (at least one page in length), and given a presentation on their policy analysis to their residency program during a mandatory conference.
Throughout the course of the curriculum, the resident is expected to participate in engagement activities that help them research their policy topic of choice
Example engagement activities:
- Meet with the chief executive officer and/or chief medical officer of the training hospital to better understand healthcare administration and how it may affect health policy.
- Attend a Performance Improvement and/or High Value Care meeting through the training hospital (if available).
- Meet with the AAFP state chapter’s legislative liaison.
- Meet with the executive director of the state medical society.
- Attend Advocacy Day hosted at the local, state, and/or national level.
- Meet with/shadow legislators and/or legislative aides.
- Meet with the chair of the health policy committee within the State Legislature.
- Meet with the director or other leadership of the state department of health and human services.
- Interview community members (including patients) to better understand their healthcare needs.
- AAFP's Advocacy Center
Links to the Family Medicine Advocacy Network, Speak Out tools, Family Medicine Issue Tracker, State Legislative Tracker, and other advocacy resources
- AAFP state chapter's advocacy webpage
Learn about advocacy priorities specific to the state in which the resident is training
- Society of Teachers of Family Medicine's Academic Family Medicine Advocacy Committee webpage
This committee represents the interests of family medicine by monitoring and advocating academic family medicine positions to appropriate government agencies.
- Robert Graham Center
Features maps, charts, and policy analysis one-pagers
- Congress.gov (formerly known as Thomas.gov)
Research current bills before Congress; Members of Congress; committee assignments; committee and session calendars
- State Government webpage
Research state house and senate members, current compiled laws, pending legislation, committee and session calendars
- Centers for Disease Control & Prevention
Statistics and maps for various diseases and public health issues
- Centers for Medicare & Medicaid Services
Federal agency that administers the nation's major healthcare programs, including Medicare, Medicaid, and the Children's Health Insurance Program.
- State Medicaid program's webpage
- Reducing physician administrative burden
- State mandate for recording and reporting all adult immunizations
- Combating the opioid epidemic, including placing an emphasis on prescriber education and initiatives that help curb diversion, such as community take-back programs as well as expending access to substance use disorder treatment
- Promote family physicians as a resource in maintaining maternity care and access to women’s healthcare, including full-spectrum reproductive services
- Preserving public health and safety
- Reforms that seek to reduce the income disparity between primary care physicians and specialists
- Reforming the payment and delivery system
- Policies and incentives that help alleviate medical school loan debt, making family medicine more attractive to aspiring physicians
- Investing in the primary care workforce
- Preserving the physician-patient relationship by opposing legislative interference in the practice of medicine
1American Academy of Family Physicians. Advocacy, 2019, https://www.aafp.org/medical-school-residency/fmig/lead/programming/advocacy.html.
2Robinson CL, Fisher M, Lane SW, Candler SG. “Creating a national health policy and advocacy curriculum.” SGIMForum. 2018;41(6): 1-2.
3Earnest MA, Wong SL, Federico SG. “Perspective: physician advocacy: what is it and how do we do it?” Journal of the Association of American Medical Colleges. 2010;85(1): 63-67.
4Long JA, Lee RS, Federico S, Battaglia C, Wong S, Earnest M. “Developing leadership and advocacy skills in medical students through service learning.” Journal of Public Health Management and Practice. 2011;17(4): 369-372.
5Hubinette MM, Ajjawi R, Dharamsi S. Family physician preceptors’ conceptualizations of health advocacy: implications for medical education. 2014; 89(11):1502-1509.6“Family Medicine.” ACGME Main Page, www.acgme.org/Specialties/Milestones/pfcatid/8/Family Medicine