Students will be provided a prompt in the discussion section below. Please respond to the prompt and respond to at least one of your student peer’s reflections for each prompt.
Critical Reflections
Service and AdvocacyA Fourth-Year Medical Student Elective
Please consider a time during medical school:
when you engaged in advocacy and either it went well or did not go as planned
– or –
a situation when you chose not to engage but wished you would have advocated
Please reflect on the following:
What
Describe the situation you encountered.
What was unique to this experience for you?
What was your response?
So what
Why do you think you responded this way?
Why was this important to you and to the community you were engaging?
What was the outcome – good or bad?
Now what
How did and will you take what you learned to your next opportunity for advocacy?
What skills and resources do you still identify needing to do this?
Please post your response and respond to at least one of your peers by August 31st.
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— comment in error —
Critical Reflection
During medical school, the predominant engagement in advocacy that comes to mind is our service-learning projects during our Learning Communities M1 – M2 year. That was the advocacy project that I’ve probably spent the most time on during medical school, and it both didn’t go as planned but also went exactly how I would have expected.
I was part of LC 13, which partnered with Su Casa. Our project centered around de-stigmatizing mental health challenges within the population that Su Casa serves, which consists of predominantly Spanish-speaking immigrants. When we first met with the community leaders at Su Casa, it was clear that our ideas didn’t exactly line up with their ideas of a “good project.” It was also clear that the 12 of us medical students were not going to agree on a subject matter, either. We all had different visions, and, when we inevitably didn’t agree, some people checked out while others doubled down on their ideas. I’d say that the vast majority of people decided that they didn’t care enough to fight or contribute meaningfully. Like in high school, the few shouldered the majority of the work while the rest of us did what we were told and the minority hardly did anything at all. As a room of high achievers and likely the ones that used to lead group projects in high school, it was strange to see us all reverting to roles that typically occur in a group but we did not typically play. Of course, there were the few type B personalities that probably took the back seat in both high school and medical school, but those, again, were the minority.
Service has been a cornerstone of my life for as long as I can remember. Upon entering medical school and hearing about the service-learning project portion of our Learning Community Curriculum, I was excited to see how much a strong group of medical students could accomplish. Individually, we were undoubtedly a strong group of students and people with steadfast beliefs and values. You’d think that our previous successes and accomplishments that were littered throughout our medical school applications would have prepared us to complete an amazing project with measurable impact and potential to be published. However, I’d argue that our project was embarrassing. How did our four online “mental health” sessions only attract ~5 Su Casa clients each? How do we put “data” on a poster presentation with only 20 data points? How did we manage to get such poor participation in the groups? When I led my group, half the clients were distracted and unengaged, the other half seeking personal medical advice about a relative with bipolar disorder or the like, which as an M1 – M2 I didn’t feel qualified to speak on. It felt like we truly didn’t do anything and rather wasted everyone’s time.
However, my LC was selected to present our project to the Vice Mayor of Cincinnati. We received recognition because we attempted to address a valid concern – the high rates of trauma, PTSD, and other mental health concerns in the immigrant population. Our classmates and the Vice Mayor acknowledged the health gap present for these communities in Cincinnati. We advocated for increased support and funding for bilingual mental health professionals. Su Casa shared with us that their most ill clients had to wait ~12 months to see a qualified bilingual mental health professional after an initial one or two “crisis” visits. A terrifying need was there, but we did not address it. Perhaps this comes from a place of hubris, but I truly thoughts that coming into medical school that such a strong group of students would have been able to make an impact on clients/patients themselves. Although we got recognition at a higher level, there was no direct impact that I could see on the active mental health crisis that the clients at Su Casa were facing. We couldn’t (or wouldn’t) do it. Who would?
Throughout this experience, I learned how important buy-in is from a group. I also learned that groups of medical professionals are just as dysfunctional as most groups of high school students. When I think about successful advocacy, I picture a smaller group of engaged individuals that truly want to make an impact and won’t be content with an embarrassing result. It’d be a group that took pride in their work and is not looking to satisfy minimums or pretend to be interested in service for an application. An inspiring leader, not just a workhorse that everyone can depend on to turn assignments in on time, is needed. At this point in my life, I need to develop leadership skills to become this person.
Katie, I wish you, nor the community, did not experience this, but I hope your vision for the future will lead you to greater service and enable you to lead others who are committed just as much as you are.
Thank you for sharing this experience, Katie. I really appreciate your honesty of tough group dynamics, even within a group of super high achieving medical students. Your last paragraph made me think of our readings from last month about effective community partnerships, and the struggle that can come in community when service is glued to academic requirements or a calendar. I could hear in your other paragraphs how important this work was to you, so I know being that inspiring leader is in your future.
During one of my clinical rotations, I sat in on a multidisciplinary discharge planning meeting for a patient recovering from a gunshot wound. As different team members discussed logistics for his homegoing care, a consultant remarked that they would not feel comfortable prescribing pain medication because the patient lived in a “high-risk zip code for diversion.” The implication was clear and deeply troubling. It was one of the most overt examples of medical racism I had witnessed in real time. What made it especially striking was not only the comment itself, but the silence that initially followed. I was the only medical student in the room, surrounded by senior clinicians. I froze. I wanted to speak, but all I could do was listen while others, fortunately, began to push back.
I believe I stayed silent out of fear. I was afraid of speaking out of place, of being seen as disrespectful, or of jeopardizing my evaluation. Medical training is hierarchical, and while we are taught to advocate for patients, we are also socialized to understand our position. In that moment, I chose self-protection over patient protection. Thankfully, my attending modeled what advocacy can look like. They addressed the issue directly, ensured the patient received the appropriate medication, and later debriefed with the team about how bias can affect clinical decision-making. It was a powerful example of how advocacy, when practiced by someone in a position of authority, can change a patient’s care.
From this experience, I have learned that silence is a choice, and not a neutral one. To be silent is to be complicit. The next time I witness bias or injustice in patient care, I want to be brave enough to speak up, regardless of my role. That does not mean ignoring hierarchy, but rather acting within my position (whether that means asking a question, following up one-on-one, or raising a concern through the appropriate channel). I also recognize that I need support to do this well. Advocacy cannot exist in isolation. It requires institutional backing, clear protections for trainees, and faculty members who are willing to stand with us. As I continue through training, I hope to grow not just in medical knowledge but in the confidence to use my voice for those who cannot always speak for themselves.
Noah, I am glad you had advocacy modeled in this setting. You are right- it cannot exist in isolation, but unfortunately, it often does. I like your push for us to be better.
Noah, I very much resonate with your narrative. I admit it feels freeing after M3 year when on away rotations, I feel heard as an equal and an “almost” provider. Worried about my evaluations during M3, I admit more often than not I was hesitant to speak my mind about many medical decisions for fear of retribution or evaluation. This was further engrained after I knew a patient was nearing the end of life and I repetitively told our team it was time to back off of intensive medical treatment, consult our palliative colleagues and have discussions with the family. I saw nods but heard no words. I came in later the next day and the patient had passed, no palliative, no end-of-life care. I was frustrated with our team and empathetic for the family.
Noah, thank you so much for sharing this story with us! It’s incredibly difficult to see such an overt example of medical racism, and I’m so glad that it seems like you reflected strongly on this. The lessons you’re learning right now are going to make you a fantastic clinician in the future who can advocate for patients.
I also really resonated with the part about silence being complicit. I completely agree, and wish this was something that we could change about the medical education system. I’ve stayed silent at points over the past two years for fear of retribution, but its the lessons learned that will stay with us in residency and beyond.
As a member of the Student Wellness Committee, I noticed that many of my classmates were quietly struggling with burnout, but hesitated to seek help. It’s often daunting in medical school to show vulnerability because many view this as weakness or not cut of the same cloth as your fellow medical student peers. One afternoon, during an open forum medical grand rounds presentation, a student shared that they had delayed reaching out for counseling because they didn’t know the process or feared judgment. Medical school training is hard in and of itself, muchless managing the emotional toll resulting from years of repetitive studying and long work hours. That moment stuck with me—it was raw and honest, and I realized it wasn’t an isolated experience. I asked myself how I could help in a way that wasn’t belittling but empowering. Is there a process that could target groups of people and not individuals? In response, I worked with the committee to propose a new initiative: a peer-led information session on how to maintain compassion as a tool to preserve the provider and advance patient outcomes. I knew from undergrad the very basics of a simple model, and was eager to apply this to our medical school, not as a lecture series, but rather an opportunity to share lived experiences and common scenarios. Furthermore, I imagined inviting providers from across the region to share how they sought help. In a bifold mission, I imagined a program that was student-led but provider enhanced.
I responded by taking initiative because I saw myself and my peers reflected in that student’s story. I knew many others most likely shared those same struggles. Advocacy here mattered to me because wellness is the foundation of learning and compassionate care, yet it often remains hidden behind stigma. I believe that compassion serves as the foundation for every encounter, allowing the clinician to feel the fruits of their labour and for the patient to experience that above all, their problem in that moment is the most important. For our college, normalizing the conversation and providing clear, accessible pathways to resources was not convenient but essential. The outcome was encouraging: attendance at that first session exceeded expectations, and several students later told me it was the first time they felt comfortable reaching out for help. Looking back as a M4 upon years of rigorous training, I’m happy to say many residencies value this, oftentimes more than just being a good doctor. As we grow through the hierarchical ranks of medical school, it’s paramount to ask how others navigate hardships in medicine. More often than not, people are willing to share when they recognize that someone else genuinely understands their struggle. I saw this firsthand on the Student Wellness Committee. What began as a single student opening up about delaying care became a ripple effect—others found courage to speak because the space felt safe and validating. That openness gave me the responsibility to advocate, not by speaking for others, but by creating opportunities for them to be heard.
This experience taught me that advocacy is most impactful when it grows from a single voice into collective change. Moving forward, I want to continue creating spaces where people feel safe to speak up and supported in taking the next step. To do this more effectively, I recognize I need to strengthen skills in program evaluation—measuring the real impact of wellness initiatives—and in building lasting collaborations with UCCOM leadership to make sure these changes endure. Actionable items that I’m working on currently include meeting with other clubs, clinic leaders, staff and students to assess what would be the most helpful and it-turn valuable to ensure UCCOM trains competent compassion-forward physicians.
Hi Quinn, I just wanted to say that I appreciate your advocacy in wellness as someone who experienced severe burnout early into M3 year. And exactly as you said, I did not get help until after several months of going through the motions and thinking in terms of “I just need to survive until the next golden weekend” because I felt help was too far unobtainable. We have too many other priorities as med students. I was thankful for the new counseling initiative that UCCOM now offers specifically for medcats, the wellness resources that are sent out every month, and now even a Mind-Body program. I honestly think the best strategy is for UCCOM to shove as many resources into our faces as frequent as possible. As you said, convenience is key for med students who are 24/7 working. It was also important for me that I was continually exposed to physicians and peers who were going through similar mental challenges. What finally shoved me into seeking help was a friend of mind sitting down and saying “let’s find a time together to schedule our therapy sessions”. It served the multi-purpose of a providing deadline for action, an accountability partner, and an understanding that I was not the only one struggling. I think it is fantastic that you are advocating for people like me, my friend, and yourself all at once.
There was a patient on my service a few months ago that I was not directly following, but knew generally of what was going on. She was a teenager coming in with nausea and vomiting while pregnant. She was at about 15 weeks according to an ultrasound that happened during her admission. She did not have familial support besides her grandmother, and her boyfriend at the time was not being a wonderful person to her. There were many unknowns about the rest of her social situation, but we did know that she wasn’t sure if continuing her pregnancy was best for her at this time in her life.
Once her nausea and vomiting improved enough to where she could keep some food and water down, I knew she was going to be discharged. I tried to skimming through the previous notes to see if anyone had placed a referral to SW or other pregnancy services since one note briefly mentioned questionable continuation of pregnancy. OBGYN had written a note saying that she could establish with their team for prenatal care if she intended to continue her pregnancy, but didn’t mention anything else. I asked my team if anyone had talked with her about what her options were if she did want to terminate her pregnancy. No one was sure / no one spoke up.
I know the climate around abortion is charged, so I don’t know if you are even allowed to chart anything around elective abortions in many medical systems. But, I also knew our patient was scared, and I felt this anxiety that I needed to be sure at least one medical provider at least mentioned to her where she could go to have an elective abortion if she wanted. In addition, I wanted her to know that there are laws in Ohio that prevent elective abortions from being provided after 22 weeks, and I was scared that people being vague about “her options” could cause her to miss her window if she decided that being pregnant was not what she wanted for her body.
This scenario felt very important to me. Before M3 rotations started, I spent a few hours each month volunteering at Planned Parenthood, supporting women coming in for elective and spontaneous abortions. As a volunteer, I was in a completely non-clinical role. Even though I knew some of the medicine behind questions that were asked of me, it was not my role to answer and instead to grab a nurse. This patient was the first time I had encountered a conversation around elective abortion in a more clinical role, and I really felt like I needed to do something. I asked my senior resident if it would be okay if I chatted with her about Planned Parenthood and what I knew about the abortion laws in Ohio. He said yes, and up I went.
I have absolutely no idea what happened when this patient and her grandma left the hospital. I hope they felt empowered to make the choice best for them at this time, and at least felt equipped with some knowledge to do so. The stigma & political intensity surrounding abortion care is heavy and hard for me. I feel nervous to talk about it, and I feel scared for the future of reproductive justice and freedoms for women and others with a uterus. I was proud of myself for speaking to this patient, and actually saying the word “abortion” instead of “options” to a scared teenager. I am nervous still that I didn’t say the right thing. I hope that I won’t let the fear of saying the perfect thing keep me from talking to many more patients in the future like this one. I hope further experience with the medical system and understanding how things work will continue to build my confidence in patient level advocacy.
Caroline, thank you so much for being an advocate in a moment when you noticed a patient needed it. I also feel myself dance around the word “abortion” now that so many are being charged for being involved in this necessary medical procedure. Your sentence “ I hope that I won’t let the fear of saying the perfect thing keep me from talking to many more patients in the future like this one” speaks volumes to me. I feel scared for the future, too. But I take comfort in knowing advocates like you exist in that future.
During my time working at the day program, one of our individuals had just returned to the day program from a hospitalization due to a small intestinal obstruction. He was ecstatic to be back and greeted all of us with hugs. However, as the morning progressed, he continued to get more agitated. He requested to go to the bathroom multiple times, and each time, he sat at the toilet for several minutes before giving up and leaving. It was clear that although he wasn’t straining, he was not feeling well, and this was certainly echoed during lunchtime when he refused to eat his food. This was unusual for him as I knew in the past, I had to remind him to slow down to prevent him from choking on his food. All this to say that I had indications through his behaviors and recent history that he was feeling constipated. However, my colleagues believed that he was just seeking attention by requesting to go to the bathroom without really having to use it. And while this individual was nonverbal, he understood what those around him were saying, and he continually became more agitated as the afternoon went on. This agitation culminated into an MUI as he accidentally hurt a fellow day program attendee while pushing his wheelchair around defiantly and aimlessly. Everyone reacted to this individual with anger, which only increased his maladaptive behaviors. One of my colleagues and I had to leap in and remove him from the situation to defuse his behaviors. And due to the MUI, the individual was to be removed from the program.
However, having seen what led to the agitation, I knew the individual was not to blame nor was he trying to hurt his friend intentionally. I advocated for his reevaluation by the state’s behaviorist to my supervisor, and with her observation of his behaviors throughout the week, he was evaluated to still be appropriate for the day program. It was important to me that someone spoke up for this individual as I knew he could not speak for himself. And my perspective was valuable as it was different from my coworkers and could really change this individual’s ability to get into any day program in the future, never mind staying in ours. His inability to attend a day program would have been a complete injustice, as he benefitted from the social interactions, as evidenced by the way he got excited about going on bus trips and seeing the workers at the program. And I knew his heart. He was harmless and was only trying to communicate his frustration that day. This individual never showed this same sign of agitation in the past and he never did again as he continued his time at the program. I believe the outcome was more good than bad as an individual who deserved to continue at the day program was able to stay. In addition, it prompted his provider at his resident to increase his bowel regimen. However, one of my coworkers did resign that day as they disagreed with the supervisor’s decision, so part of me did feel fault in that loss. In hindsight, I wish I had spoken up for the individual to my other coworkers more strongly in the moment. I think helping to change the way the coworkers thought and reacted to this individual’s behaviors during that morning would have prevented the incident in the first place. The main skill I want to grow for next time is a more confident reserve to speak up. With the power dynamics and imposter syndrome I felt in being a new volunteer around those already established, it felt more difficult for me to stand my ground against my coworkers. Now that I have gotten to know my coworkers more, I know that I feel safer to discuss disagreements with them in the spur of the moment.
This is a very powerful story Trong! “I know his heart” really sticks out to me here, as you very clearly did the best you could for this individual and were there for him as an advocate when he could not do that for himself. I am saddened by the end of your story when the co-worker left due to the situation as well. It sounds as if you work with a very socially and medically complex population, and that lends itself to interpersonally stressful situations.
I am impressed by your self-awareness here and your ability to identify the confidence to speak up as such a crucial factor to work on. I have also struggled with feeling imposter syndrome, and often feel my throat getting stuck whenever I try to speak up in a situation where I am feeling that. I don’t have an answer for this personally, but how do you think we can feel empowered to speak up in those situations when fighting through that feeling?
Our service learning course during M1 year did not go as smoothly as we had planned. I think my LC had great intentions and wanted to do great things for CAIN. We also had just started medical school and did not understand how much learning we were about to commence in. I also think we did not understand the needs of a community partner. When Aileen first presented us with the projects that CAIN needed help with, I think we were all a little confused about how exactly this would relate to the rest of our medical school learning. We were also a little confused about how the priorities of CAIN and the priorities of us as medical students were going to align. Nevertheless, we found a project idea that CAIN was excited about and we were too, and got to work.
We started out with the goal of creating a way for the children to get involved in the waiting room. We had plans for a kids corner that was going to be both educational and fun, and then we had plans for kids games that we would paint onto the concrete of CAIN. After we had spent a bit of time preparing this, we realized that the waiting process of CAIN was going to change so that families would not be in the waiting area for as long, and that the outside was going to be repaved shortly after our project would have commenced. I am very proud of my LC for pivoting quickly to making QR codes that opened up a portal of kid-friendly games, but this was far from our original conception, and also probably not the best option.
Having worked with kids more and now wanting to go into pediatrics, kids are constantly on their phones or their parent’s phones, so we were on the right track with the QR codes. However, I don’t think we realized how difficult it would be to attract kid’s attention to our QR codes, or how difficult it would be to maintain their attention if we got it. We still created an offering for the kids, but we shifted from the collaborative idea generation that we had done with Aileen at the start of the project to something much more impositional, because we were starting to run out of time. Overall, the outcome was still a good portal for kids, but it had poor utilization. Unfortunately, I think we were rushed by the time constraints of the project. Something I have learned with more study of community based participatory research is how often the best projects are not aligned with artificial timelines, an impossible change in the circumstances of medical school partnerships.
I am currently learning more about community based participatory research through a variety of classes I am taking, which has been great to learn these perspectives from different institutions. I know from this experience and also the classes themselves that I have a lot more to learn about how to be a good partner, and I have much work to do before I am able to implement this personally, but I am hopeful that I will eventually be a good steward of the values of the communities I partner with.
During my internal medicine AI, I cared for a 25-year-old woman with a history of systemic lupus erythematosus who had been hospitalized multiple times for severe pain flares. Her chart included language that raised red flags—phrases like “drug-seeking behavior” and “frequent flyer.” By the time she was admitted under our care, she had been to multiple emergency rooms and was labeled as difficult and manipulative. However, during our interactions, I saw someone in genuine distress who felt unheard and cornered.
What made this experience unique for me was the tension between what was written in her chart and what I saw in front of me—a young woman who was scared, exhausted, and in pain. I recognized that she had likely experienced dismissal over and over again. I chose to approach the situation with humility: I acknowledged that while we couldn’t continue high-dose IV opioids as a long-term solution, her pain was real and deserved to be treated seriously. I worked with the team and pain management to shift her toward a more sustainable, multimodal plan.
I think I responded this way because I’ve seen how dangerous and dehumanizing it can be when we allow bias to shape care. As a student, I’ve had the privilege of spending more time with patients, and I’ve learned that sometimes what they need most is someone to simply believe them. It was important to me to not just “manage” her pain medically, but to also advocate for her in a system that had most likely brushed her off multiple times
For the patient, this made a huge difference. At the end of her hospitalization, she told me I was one of the first people who didn’t treat her like an addict or a problem. She said she finally felt like she had a path forward—not just out of the hospital, but toward real, long-term relief. That moment reinforced why advocacy is not just about speaking up, but also about listening with intention and compassion.
This experience deepened my understanding that advocacy can happen quietly—in the way we document, the way we speak about patients on rounds, and the way we make space for their voices in care decisions. It also showed me the importance of bridging empathy with medical responsibility—acknowledging pain while gently steering patients toward safer, evidence-based treatment.
Moving forward, I want to strengthen my skills in trauma-informed care, addiction medicine, and motivational interviewing—tools that will help me better serve patients with complex pain and chronic illness. This experience reminded me that sometimes, the most powerful form of advocacy is treating someone with humility and lending a listening ear.
Oh no! My initial critical reflection did not go through. My apologies.
When I was on my palliative care rotation, we had a patient who was admitted in terminally ill condition with an undiagnosed cancer. He had never seen a doctor for this (or any other reason recently) because he avoided the medical system. His son had found him on the ground and brought him into the hospital.
Needless to say, this family was hurting — and they were not prepared to let go.
They were also very poor. The son was covered in tattoos, including his face. They smelled of coffee and cigarettes. I never saw them eat a meal during our time with them. On our initial encounter as a team, the son was gruff and avoidant.
When we left the room, their nurse walked up to our team and said something about how gross they smelled. The attending on our team looked to me, encouraging my response. I felt my insides flame with passion towards protecting this family’s dignity. They were going through enough – they didn’t need judgment from their healthcare team compounding this. I don’t remember exactly what I said, but it was something to the effect of, “I believe there to be a lot beneath the surface here, including financial pressures.” It took hours for me to not feel angered by that comment. I wondered if I said enough. I try to choose my words carefully in moments of passion.
Over the week, we grew better trust with this family. So much so that by the end, in his father’s final hours, the son hugged each of us in tears – not over his father’s condition, but over the grace he felt extended towards him by our team. While he was obviously grieving, he was also extremely stressed about funeral costs for his father, and he worried about missing rounds while going to the methadone clinic daily and balancing his full time job responsibilities. Our team did a lot of external things to support them — a food and coffee bar in the room, rounding at a time that worked for him, researching funeral cost supports for veterans (of which there are surprisingly few if you do not die on VA property). But the real work was internal. Everyone was honest during our daily reflections about the bias we left that initial encounter with. Some on the team expected the course with this family to be dramatic, angry, and “difficult.” Some were surprised how much of a teddy bear the son turned out to be despite his being covered in tattoos. And through reflecting on these things honestly in a safe environment, we all became better at our jobs – and we provided the best possible care to this family. They raved about the care from the nurses. They shared with us a Facebook post they made for our team. They felt we reinvigorated a sense of hope and trust in healthcare that they had lost.
This taught me how much humility is required to overcome biases. It reminded me that the care we give is important – especially to the patients who are more easily judged by others.
Unfortunately, when we transferred the patient to a hospice facility, he died rapidly, and the family experienced some harsh responses from others. But they called our team after the weekend and the social worker showed up for them again. We were a source of trust and healing, even after they left. This taught me that advocacy begins with the trust that is established from listening.
Keirsten, this is such a touching story and I really appreciate what you ended with: “advocacy begins with the trust that is established from listening”. I think one of the best ways to even be able to advocate for our patients and their families is to first intentionally listen, and to do so with as little bias as possible. And the evolution of the patient’s relationship with the care team really exemplifies how true advocacy isn’t just in what we say but also in our actions…The way we treat and care for our patients encourages our colleagues to do the same and that can be it’s own form of advocacy as well.
During my M3 Im rotation, I had a ~30-year-old nonverbal patient with autism with a history of diabetes and CKD who came in with an AKI and was found to have an A1C of 17%. What stood out to me was how many gaps there were in his care, despite his mother’s willingness to care for her son and engage with the medical system. Later in the admission,I discovered that he had been unfairly dismissed from his endocrinologist’s practice, that there was little education on how to use his glucose monitor, and his mom, who was his primary caregiver, was overwhelmed and didn’t fully understand how urgent things were.
His mother was adamant about not able to leave her son at the hospital alone because in the past she did so and came back to find him in restraints. But she wanted to leave because her own health was starting to suffer without access to her CPAP and medications, and at one point she was ready to leave with her son AMA. So in effort to make sure the patient didn’t get discharged prematurely, I spent time talking with her and trying to bridge that gap. I also advocated for him to be seen by endocrinology before discharge, since he had no active endocrine care and was already following with nephrology at UC. The team had been planning to discharge without that, but I pushed for the consult and endo did end up seeing him and setting up follow-up. At the same time, the situation escalated when the team contacted the patient’s sister to override the mom’s decision, which backfired. I found myself in the middle trying to maintain communication between everyone. Later, his mom was crying and said she was willing to stay because she cared about her son’s health, but by then the plan had already shifted toward discharge.
I think I responded the way I did because I felt a strong responsibility toward both the patient and his mom. He couldn’t advocate for himself, and she was doing her best in a really overwhelming situation. It was important to me that she felt heard and that we didn’t miss something as basic as making sure he had appropriate follow-up. I did advocate in the ways I could, but I was also limited as a medical student, especially once decisions were being made above me. Looking back, I can see both the impact of speaking up and the areas where I didn’t have the ability to change the overall course.
Going forward, I want to build on what I was able to do in this situation and expand it. I did advocate within my role by pushing for the endocrinology consult and helping maintain communication, and I saw that it made a real difference in his care. As I move into residency, I’ll have more authority in decision-making, and I want to use that to take ownership more fully, especially in situations where there are clear gaps or misalignment in the plan.
I think what I still need is more confidence and experience navigating those moments when there’s tension or when plans are moving quickly. In this case, I was able to advocate within my scope, but I didn’t always know how to push further once decisions were being made above me. I want to get better at escalating concerns appropriately, communicating clearly across teams, and staying grounded when emotions are high. Learning from residents and attendings who do this well, and continuing to strengthen my clinical judgment, will be important so that I can advocate in a way that is both effective and respectful.