‘A drive to make change’ - Exploring the views and experiences of medical students engaging in advocacy: a qualitative study.

Problem

Advocacy is an important component of medicine and a recognised competency for medical graduates. Many undergraduate medical students engage in advocacy activities, but research on this topic is limited. This study aimed to explore the views and experiences of medical student advocates, and how advocacy work influences their career aspirations.

Approach

This was a qualitative study using semi-structured interviews at the University of Glasgow. Participants were recruited by purposive sampling of medical student advocacy networks to identify information-rich cases. One-on-one interviews were conducted online via Zoom, which were recorded, transcribed, and anonymised. Thematic analysis was used to generate codes from the anonymised transcripts. Codes and discrepancies were cross-checked and finalised codes were applied to the data set to develop themes and sub-themes.

Findings

Nine medical students were interviewed which included three men and six women from a variety of student advocacy organisations. There were five themes: triggers and enablers; barriers and disablers; knowledge, skills, and attributes; advocacy in the role of health professionals, and career aspirations; and teaching and assessment of advocacy. The main triggers and enablers for medical students to pursue advocacy included internal drivers (e.g. intrinsic drive and personal experiences of injustice), and external drivers (e.g. role models and the advocacy community). Obstacles for engagement in advocacy activities included lack of institutional support, personal challenges, and discomfort around professionalism in advocacy. Through advocacy work, student enhanced their knowledge of social issues and improved communication skills. Students discovered camaraderie as a part of advocacy communities and found a sense of purpose. Advocacy activities strongly influenced students’ future plans. Most agreed that advocacy is an important topic in medical education, suggesting teaching it early in medical school via small-group tutorials and role-modeling. For assessment, a reflective approach was preferred over written exams.

Consequences

Medical students’ engagement in advocacy has complex facilitators and barriers, and the relationship between advocacy and professionalism requires clarity. Benefits of advocacy include fostering empathy and other transferable skills required of future doctors. The main barriers to medical student advocacy are similar to those experienced by physicians, including clashes with authority figures and politicisation of advocacy work. Advocacy teaching was welcomed by students, with suggested teaching and assessment approaches proposed. The optimal learning and assessment strategy remains uncertain, and medical institutes will benefit from further research on this topic. This study presents an opportunity for dialogue with medical faculty in Glasgow and wider afield to prompt discussion about advocacy teaching and provide clarity on the interaction between advocacy and professionalism. The suggestions put forward by participants provide a helpful starting point for such discussions.