P0142 - Pediatric Resident Engagement in Advocacy Does Not Match Attitudes

Background/Purpose
Advocacy is increasingly recognized as a core element of the physician’s responsibilities. Health advocacy training is an essential part of postgraduate medical education for pediatricians and a required curricular element of the Accreditation Council for Graduate Medical Education (ACGME). However, efforts to advance advocacy curriculum thus far have been inconsistent. Most pediatric trainee advocacy education is limited to a two-week to four-week advocacy rotation without a longitudinal component. We sought to understand whether additional training would be beneficial to equip residents with skills needed to effectively engage in the broad range of advocacy activities and promote systems-level improvements in health equity.

The purpose of this study was to collect baseline information about resident competency, comfort and participation in advocacy. We also sought to compare attitudes toward the importance of advocacy and plans to participate in future advocacy activities with reported recent participation in advocacy. We wanted to better understand baseline resident knowledge about policies and legislation affecting marginalized populations. Furthermore, we hoped to identify knowledge gaps and barriers to advocacy participation that could be used to inform our intervention.

Methods
This study was performed at a single center pediatric residency program. Our questionnaire was modeled after a previously published tool used to collect information on resident attitudes toward advocacy. Data was collected using REDCap over a two-week period and analyzed using Microsoft Excel.

Results
62% of residents completed the survey. The majority of residents felt comfortable (90%) and competent (77%) advocating for their patients in a clinical setting, but less comfortable participating in various forms of legislative or public advocacy. Most agreed that they have a duty as a physician to advocate for their patients (98%), that their role as an advocate extends beyond the individual patients they are treating (89%), and that physician advocacy can change legislation (85%). Moreover, most residents agreed that advocacy training should be a part of residency education (85%) and many plan to be involved in advocacy during their career as a physician (61%).

While 70% of residents reported participating in at least one form of non-clinical advocacy in the past 6 months, only 46% reported participating more than once. Major barriers to resident participation in advocacy were time (63%) and knowledge (15%). Only a minority of residents could accurately identify statutes regarding LGBTQ youth rights (26% correct) or define public charge (44% correct).

Conclusions
Pediatric residents understand the importance of physician advocacy, but participate at lower rates than their attitudes would suggest. Interventions that require minimal time commitment and can fill in knowledge gaps may empower residents to address health disparities facing pediatric populations on a broader systems-level scale.