Formal advocacy curricula in family medicine residencies: A cera survey of program directors

BACKGROUND AND OBJECTIVES: Health advocacy has been declared an essential physician skill in numerous professional physician charters. However, there is limited literature on whether, and how, family medicine residencies teach this skill. Our aim was to determine the prevalence of a formal mandatory advocacy curriculum among US family medicine residencies, barriers to implementation, and what characteristics might predict its presence. METHODS: Questions about residency advocacy curricula, residency characteristics, and program director (PD) attitudes toward family medicine and advocacy were included in the 2017 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency PDs. We used univariate and bivariate statistics to describe residency characteristics, PD attitudes, the presence of a formal advocacy curriculum, and the relationship between these. RESULTS: Of 478 PDs, 261 (54.6%) responded to the survey and 236/261 (90.4%) completed the full advocacy module. Just over one-third (37.7%, (89/236)) of residencies reported the presence of a mandatory formal advocacy curriculum, of which 86.7% (78/89) focused on community advocacy. The most common barrier was curricular flexibility. Having an advocacy curriculum was positively associated with faculty experience and optimistic PD attitudes toward advocacy. CONCLUSIONS: In a national survey of family medicine PDs, only one-third of responding PDs reported a mandatory advocacy curriculum, most focusing on community advocacy. The largest barrier to implementation was curricular flexibility. More research is needed to explore the best strategies to implement these types of curricula and the long-term impacts of formal training.