|CanMEDS 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.
Key Competencies for Physicians:
- Respond to individual patient health needs and issues as part of patient care
- Respond to the health needs of the communities that they serve
- Identify the determinants of health of the populations they serve
- Promote the health of individual patients, communities and populations
For more information on the Advocate role, including a detailed description of the enabling competencies:
Robert J. Sargeant MD, PhD, FRCPC
Assistant Professor, Division of General Internal Medicine
St. Michael’s Hospital
Suite 4-140, Cardinal Carter Wing
30 Bond Street
Tel: (416) 864-5361
Fax: (416) 864-5714
|Practical Tips to Teach & Evaluate the Health Advocate Role|
Ask the trainee to identify one health need of an individual patient. He or she will then be asked to identify a potential plan to address that need. For example, a patient may not have a primary care physician. The resident or student could provide the patient with the telephone number of the family practice registry at the CPSO that might assist the patient in finding a family doctor in their geographic area. An alternative plan would be to have the trainee contact family practice clinics on behalf of the patient in an attempt to identify a family physician who is taking new patients.
Ask trainees to identify one or more health needs at the time of admission of the patient to hospital. He or she would then be asked to report back to the attending physician on the day following admission with a plan to address those needs. A workable plan would likely include communication with members of the multidisciplinary team (social worker, discharge planner, nutritionist, occupational therapist etc.) to access all available in-patient and out-patient resources.
What are “Determinants of Health”?
The determinants health as outlined in the Jakarta Declaration:
- Physical Environment
- Stable ecosystem
- Sustainable resources
- Social Environment
- Social security
- Social justice and respect for human rights
- Access to health care services
- Biological and behavioral determinants of health
- Genetic factors such as ethnicity
- Lifestyle factors such as immigration, smoking etc
Questions to Ponder
What is the relationship between being a Health Advocacy and Ethical Medical Practice? How are they similar? How do they differ?
Dr. Rob Sargeant graduated from the University of Toronto Faculty of Medicine in 2000. He completed his postgraduate training in General Internal Medicine at U of T in 2004 and the Master Teacher Program in the Department of Medicine in 2005. He is currently a staff internist and clinician teacher at St. Michael’s Hospital with special interests in undergraduate medical education and wound care. He is the Fitzgerald Academy coordinator of the second year Determinants of Community Health course and the clerkship coordinator for third year medical students at St. Michael's Hospital. His current education interests include projects to improve the effectiveness of bedside teaching and an integrated, multidisciplinary curriculum to teach the assessment and management of medical wounds.
|CanMEDS Health Advocate Role Resources and Best Practices|
Campbell , ME. Women's Access to Nevirapine to Prevent Mother-to-Child Transmission of HIV: A Case Study of Policy Development in South Africa . 2003: Unpublished Masters thesis, University of Toronto . Accessible at http://individual.utoronto.ca/melaniecampbell/ (accessed Feb. 15, 2005)
Coyle JT. Pine DS. Charney DS. Lewis L. Nemeroff CB. Carlson GA. Joshi PT. Reiss D. Todd RD. Hellander M. Depression and Bipolar Support Alliance Consensus Development Panel. Depression and bipolar support alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 42(12):1494-503, 2003 Dec.
Creswell, JW. Qualitative inquiry and research design : choosing among five traditions.
1998: Thousand Oaks, California: Sage Publications.
Frank, JR. Research Associate, Office of Education - CanMEDS, Royal College of Physicians and Surgeons. Personal communication, January 25, 2005.
Frank JR, Cole G, Lee C, Mikhael N, Jabbour M. Progress in paradigm shift: the Royal College of Physicians and Surgeons of Canada CanMEDS Implementation Survey. Office of Education , Royal College of Physicians and Surgeons of Canada, University of Ottawa, Ottawa, Canada. Presented at the annual meeting of the Association of Canadian Medical Colleges, Quebec City, Quebec, 2003.
Frank, JR, Langer, B. Collaboration, communication, management, and advocacy: teaching surgeons new skills through the CanMEDS Project. World J Surg, 2003 Aug;27(8):972-8; discussion 978.
Health Canada. Chronic Diseases in Canada. 2002;23(4):124.
Inner City Health. St. Michael's Hospital. http://www.stmichaelshospital.com/content/programs/inner_city.asp
(accessed Nov. 20, 2004).
Kim JJ. American Academy of Pediatrics Committee on Environmental Health. Ambient air pollution: health hazards to children. Pediatrics, 114(6):1699-707, 2004 Dec.
Maudsley RF, Wilson DR, Neufeld VR, Hennen BK, DeVillaer MR, Wakefield J, MacFadyen J, Turnbull JM, Weston WW, Brown MG, Frank JR, Richardson D. Educating future physicians for Ontario: phase II. Acad Med, 2000 Feb;75(2):113-26.
Medical Programs. St. Michael's Hospital. http://www.stmichaelshospital.com/content/programs/medical.asp
(accessed Nov. 20, 2004).
Mission Statement. St. Michael's Hospital. http://www.stmichaelshospital.com/content/about_us/mission.asp
(accessed Nov. 20, 2004).
Neufeld VR, Maudsley RF, Pickering RJ, Turnbull JM, Weston WW, Brown MG, Simpson JC. Educating future physicians for Ontario. Acad Med, 1998 Nov;73(11):1133-48.
Oandasan, I. Barker, K.K. Educating for Advocacy: Exploring the Source and Substance of Community-Reponsive Physicians. Acad Med, 2003 Oct;78(10):Suppl.S16-S19.
Shah, CP. Public Health and Preventative Medicine in Canada. Toronto: Elsevier Saunders, 2003, p. 18.
Skills for the New Millennium - Report of the Societal Needs Working Group. The Royal College of Physicians and Surgeons of Canada's Canadian Medical Education Directions for Specialists 2000 Project. Sept. 1996. http://rcpsc.medical.org/canmeds/CanMEDS_e.pdf (accessed Sept. 20, 2004).
Stake, RE. "Case Studies." Pp. 435-454 in Handbook of Qualitative Research, 2nd Edition, edited by Denzin. 2000: Thousand Oaks, California: Sage Publications.
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 Jan;80(1):103-8.
World Health Organization. Jakarta Declaration on Leading Health Promotion into the 21st Century. 1997. http://www.who.int/hpr/NPH/docs/jakarta_declaration_en.pdf
(accessed Nov. 21, 2004).
Yin, RK. Case study research : design and methods. 2003: Thousand Oaks: Sage Publications.