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.
Reflections
Service and AdvocacyA Fourth-Year Medical Student Elective
Service and AdvocacyStudents 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.
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
So what
Now what
Back in M2, we had a panel with LGTBQ+ folks who spoke about their experiences with health care. There was some frustration among the queer students in our class-which I generally shared-that it didn’t show breadth of experiences and didn’t offer many actionable information for our classmates to apply to their own patient care. The class above us had had similar frustrations with this panel. Another classmate and I met with the person who organized the panel to discuss improvements. However, the meeting did not quite go as planned. It became more focused on the gaps in LGBTQ+ health training that we received at UCCOM. At the end of the meeting, I planned to do an audit of the curriculum thus far to ID all the places where we learned about LGBTQ health. But other things got in the way, and I never did that task. I just let it drop. I felt guilty that I had partially taken an opportunity to make an important change and then didn’t follow through. I felt guiltier the next year when the next class of M2s experienced the same panel and had the same frustrations.
As a “queer elder,” as one of my classmates called me, I feel a responsibility to improve the care my community receives. These mandatory events are vital places to do it, because we can reach students who generally have no interest in the topic. It is possible that even if I had done a thorough audit, brought it to the administration and suggested changes that there would have been no big shifts in the panel or our education as a whole. But I am disappointed that I did not have the time or energy to try a bit harder.
For the now what…I will have a lot more time in my M4 year than I have so far. Maybe this is exactly the right time to try to make some changes. I would need help from some course directors to review their course content. I would need some support from classmates and likely faculty to both bring this to the attention of curriculum committee and to suggest improvements. It would take time, but it’s definitely possible.
I think it is an interesting point you bring up as when you say that you feel a responsibility to your community as a “queer elder.” I cant imagine that pressure one feels as a community representative, but it sounds like you may have found the space to focus on it this year. I truly do believe we all have the capacity to make one intervention or focus on one issue or even one issue at a time, and it is encouraging that it is still something you feel very passionate about. It feels like there will always be some social issue or healthcare determinant that could be addressed, and I definitely do feel guilty about not having tried to intervene earlier or given more time. I think that reflection in it of itself is necessary to make meaningful change because it may not be most efficient to try and solve everything at once, as obvious as that sound haha.
Hi Taylor! You made an interesting point in your discussion, which I think evokes a lot of the same emotions I felt during the time I discussed in my advocacy post. As advocates, we feel a sense of responsibility to others and to do anything and everything we can to help. However, in my case there was a concern for safety and retribution, and in your case there was a problem of logistics, and quite frankly finding the time in our busy schedules to do what we know would so greatly help others. I also appreciate how you brought up the need for buy in from others to be able to make an impact. While so many of us hope to make changes in our curriculum or our community, we also need those in power to be willing to work with us. I think this is part of why it is so important for all of us to speak up, because while it is easy for those in positions of power to ignore a single person, it is harder for them to ignore ~180 of us calling for change.
Taylor, I remember this mandatory event and remember feeling like the content was very different from the title of the event and we did not learn about the health disparities that patients of the LGTBQ+ community faces or actionable steps. I think it’s amazing you put in the effort that you did, and I would encourage you not to be too hard on yourself. I’m sure you were dedicating your time towards very meaningful things at that time. That being said, it’s great that you are still thinking about intervening. Perhaps a google survey being sent out to the current M2 class prior to the session asking what they would like too be addressed would be a good (and easy on your part) way to make sure the audience benefits from the event. However, I recognize you’re interested in the overall curriculum and I think that would also be very meaningful and beneficial. I would love to know how this goes and if you end up pursuing this curriculum audit. I think many people would be interested in helping (students, residents, and faculty)
During our Learning Community project our first 2 years, the leader of the clinic we were working with- and whom the clinic is now named after- became ill and passed away. We needed to work with this clinic specifically due to our project being aimed at bettering the healthcare experience for those with intellectual and developmental disabilities. Many of us in the LC were disappointed that our work with the clinic was stalled because most of us are related to or know someone with these disabilities and wanted to do our best to make a friendlier environment for them when receiving healthcare services. We definitely understood the need to delay, but were disappointed, nonetheless. We pivoted to working with a different clinic through the Christ system, but unfortunately it was late in the year and the time we had to build a relationship with the clinic was short. We did end up developing a program for training healthcare professionals to better serve individuals with disabilities and provide trauma-informed care, but we felt the program did not reach its full potential.
I think we were all a little surprised by all the scheduling and coordination it took to complete our project. We were disappointed that we weren’t able to have more of an impact and that our project didn’t feel fully completed. In the future, it’s important to have plans or people to continue your project after your time is up. Also, it’s important to anticipate issues with your project and be flexible when problems arise. Having a back up plan in mind or having discussions about what different directions the projects can go is important so it doesn’t derail your project or send you back to square one. Overall it was still a great experience, and taught me a lot about how to approach future projects.
Jenna, it sounds like you guys were still able to make the most of the situation despite the setbacks you all faced! I think you make a great point about anticipating issues with projects so that you can plan ahead. It’s always difficult to react in the moment when something doesn’t go according to plan, but having back ups in place can make it easier. I also think you make a good point talking about the short time you had to build a relationship with a new clinic. It really shows that advocacy is something that takes a significant amount of time and is a longitudinal process. Building relationships with the community itself and community partners is essential to any type of advocacy work, and can be very difficult to do on such a short timeline.
I completely agree with your point about having back up plans when working in the advocacy realm; while the circumstances of our LC project changing were definitely unexpected, I’m sure last minute changes/pivots happen more commonly than one would expect in this field. Additionally, I agree that it would have been a good idea for our team to have made plans for the following year’s LC to take over our project – had there been more time to complete it, I anticipate that more could have been done to implement the teaching we wanted to do.
This is before coming to medical school. But back in college, we had a class discussion on food insecurity and were discussing the prevalence of food insecurity among college students. I even had some classmates that were willing to share stories of their own. I had no idea what some of my classmates were going through in addition to their college workload. Around the same time, I had learned about the amount of food waste we produce here in America. I began working with a classmate of mine to see if we could somehow both advocate for our classmates via social media and campus resources, while also utilizing the campus dining halls to collect unserved food that maybe going to waste and finding a way to distribute it to students who may need it. We started coming up with a plan and reached out to the dining halls to see if they’d be willing to meet us. We sent numerous follow up emails with the dining halls, and were eventually met with a response of “we’re not really interested”. All of our ideas sort of came to a stand still, and after trying to think through where to go from there, we ultimately just gave up. I hadn’t really every tried to start up any sort of initiative of my own, and quite honestly didn’t really know what I was doing. I felt bad for just dropping the project at the first obstacle, and wish I had tried harder. Even if the food collection aspect of this idea wasn’t going to be possible, we could have still advocated for our classmates via social media or through public forums on campus. For the “Now What” portion, I’ve realized in hindsight that any sort of advocacy work truly does require a significant amount of teamwork. Not only does it give you more help overall, but it increases diversity of thought. Maybe if there weren’t just two of us, we would have been able to come up with a solution of where to go from there, or how to convince the dining halls to hear our idea out. Maybe we would have found other avenues to explore aside from dining halls. And with a larger team, we would have been able to share some of the workload so that it didn’t take any one individual away from other responsibilities they had. I’ve also learned that any sort of advocacy takes a significant amount of persistence and determination. If change was easy, then it would have already happened. In this scenario, I stopped at the first sign of resistance, which shouldn’t have been the case. It’s important to think of obstacles and barriers to success ahead of time, so that you can try and plan for them accordingly. I think that’s a big lesson that I can take with me to future opportunities for advocacy.
I appreciate this example of advocacy because it highlights how often unexpected challenges come up that can stall out a project and how much work it can take to start an initiative. The more that I attempt to be involved in advocacy, the more I appreciate how many external factors are at play and how many supportive people must come together to achieve success. I think being aware of this before attempting a project and seeing where others have had challenges can really benefit long-term outcomes.
What
During M3, I volunteered to help with an HPV vaccination brigade at the Student-Run Free Health Clinic at the Healing Center. This held particular significance to me since my PhD focused on HPV-driven diseases, such as head and neck cancer, and the HPV vaccine has been shown to be an effective preventative measure. While I had done a lot of discovery science research on HPV – for example, looking at gene expression changes with HPV infection in in vitro cultured epithelium to identify new targets – this is significantly different than clinical interactions and far removed from discussing the vaccine as prevention. Going into the brigade, I thought it would be relatively straightforward to recruit those wanting to receive the vaccine. I was surprised by how few people that opted to get the vaccine, with men particularly more likely to decline, despite not being already vaccinated. The reaction to being asked tended to be much more negative than I expected, and I found it difficult to talk through reasons why an individual was hesitant or declining as many were emotions based. I feel like I ended up not trying as hard as I could to discuss an individual’s thought process in declining, and not taking the opportunity to provide more education.
So what
I don’t think I was realistic in my expectations and set myself up to be discouraged quickly. This was the first time I experienced significant resistance to vaccinations while in the role of a real life healthcare provider (eg prior to my pediatrics clerkship during flu season). Feeling discouraged and not engaging maximally to provide education to an underserved community was ultimately a result of applying my own perspective (of course wanting an HPV vaccination on a personal level) to others and not taking the time to understand beforehand the reasons behind opposition or perspective of the community we were trying to help. While this may not have had a large impact on outcomes of the brigade, this was an important lesson for me setting expectations and preparing realistically when undertaking advocacy.
Now what
This experience was eye-opening in demonstrating how important it is to understand the viewpoint and perspective of a community before offering an intervention, and how external initiatives may have additional hurdles to achieve success. While unvaccinated members of the community at the Hope Center could benefit from HPV vaccination, it is far harder to implement an initiative that doesn’t come organically as a want from the community. I don’t think that it means that an externally-driven initiative can’t have success, but rather that it’s critical to tailor the initial approach more towards education, for example.
During my family medicine clerkship, I met an immigrant family who had recently arrived in the U.S. In addition to needing medical care, they also required significant social support. As a medical student with more flexibility than my residents, I chose to step into the role of an advocate. I ensured that this family received the attention they needed, were connected with social work, and were informed about community organizations that could assist them as they settled in Cincinnati.
I believe I responded this way because I have a strong conviction to support underserved patients and firmly believe that everyone deserves for basic needs to be met and access to quality healthcare. By the end of our appointment, the family had the necessary referrals for specialty care and a clear plan for accessing resources moving forward. This experience not only increased my awareness of available government services and community organizations, but it has also proven valuable when working with patients in similar situations. I believe it is essential for physicians to remain engaged in their communities and knowledgeable about the resources patients can utilize.
Yesterday September 24th, 2024, Marcellus Williams was executed by the Missouri state government for a crime that mishandled evidence overwhelming does not prove he committed. Since reading Just Mercy by Bryan Stevenson, I have loosely followed the Innocence Project and their work to free unjusticely imprisoned individuals on Death row on social media. This month they were campaigning for the 3rd stay of execution for Marcellus which included getting emails and text updates to call government officials. I participated by calling my official and stuttered through my reasoning, sharing posts on social media and talking to my friends about this issue. However, yesterday the governor did not give clemency and Marcellus was murdered. I am still very conflicted. I am upset and hollow with the thought our justice system continues to kill innocent people despite nationwide protest and how useless my small voice feels. This was definitely a different form of advocacy and therefore, I did not have a close relationship to the affected community and those in power. I recognize that change takes time and is difficult to see as the size of the population you hope to impact grows larger, but I think the idea of state sanctioned murder is powerful enough that I will continue to advocate against. The only thing I worry about is the emotional burden and the privilege to enjoy life and occasionally share a post. I think everyone has the ability to choose one avenue to enact advocacy, one issue they care about and one method by which they can advocate for it. I am not quite sure I have found mine. And just a cursory effort to support one on a nationwide campaign has also left me feeling very useless. I hope in the future I can prioritize that issue and method in my career so that it does not become something that will burn me out. I think this is why being so close to a community is necessary, They are your support and motivation and the relationships to the people can be the thing that keeps you from breaking down. Or at least I hope so. My friends have helped me today.
One of the most recent times I advocated on a large scale was during a M3/M4 bystander training seminar. I cannot remember the specific name of the event, but it was a multiple day seminar hosted by some of our classmates during which our class was invited to share stories from our M3 years. The stories were meant to focus on times when we either witnessed or were part of situations where other healthcare professionals were acting inappropriately, whether that be through acts of prejudice or generally unprofessional behavior. I was asked by someone leading the event to share the story of my surgery rotation, where I faced blatant sexism and learned of residents who, frankly, faced much worse than me. One of the residents I worked with was asked to leave the program after she returned from maternity leave, and another was bullied out of the program due to their race. I shared these stories with the current M3 class to warn them about things they may see, and with the hope that as a group and with the perspective of the M4 class, we could discuss ways to respond to this. Personally, I waited until months later beforeI felt comfortable reporting what happened. I am still unsure if this was the right decision to wait and report, but at the time I was scared of retribution if I spoke up.
At the end of the seminar, the class below us shared a lot of despair and anger about what was being shared, and asked what was going to be done to protect them. There were many other stories besides mine, and the culmination of stories distressed them. And I remember our class sharing the same emotions of feeling trapped by the system in which we work, where our grades are subject to the influences of prejudice.
Our goal of this seminar was to prepare them for their third year, and to help them remember while it is important to stand up against prejudice, it is also important to consider your own safety. And quite frankly, it might not always be safe to do or say something in the moment. Therefore there are many many options for advocating for yourself and others, and you always need to keep your own safety in mind. I have always carried some level of guilt for not doing more while on my rotation, trying to stand up for the residents who suffered from extreme forms of prejudice. As I reminded the M3 class though, you should never feel guilty for ensuring your own safety.
Grace, I remember our own pre-M3 session on this topic and I, too, felt a little helpless and overwhelmed by it. I think there is a lot of value in sharing what was done (whether it was reported, when, etc) and what the results were. But I wonder if future iterations might invite the rising M3s to participate a bit. In my previous life as a theatre kid, I worked with an activist theatre technique that allowed audience members to “tap in” to the scene and change the direction of things. We used this for bystander training on my college campus – students could tap in to take the place of “the friend” in a situation and practice ways of defending or supporting the main character. I wonder if simply asking the audience what they think could be done or what they might do might help give them back some agency.
Grace, I’m sorry that you experienced this on your surgery rotation. I think that many students shared the same experience. I think it is really admirable that you used your experience to help future students and inform them how to navigate clerkships, and it also important that we share our experiences with leadership so that our hospital can become a safe place to focus on learning and caring for patients.
What:
During the pandemic, I tried to start a virtual organization to connect high school and college students with elderly individuals in retirement homes who were feeling isolated and lonely. The goal was to help decrease their sense of loneliness through virtual Zoom calls, as they were unable to have visitors. This experience was unique to me because it was my first time tackling such an initiative and navigating the challenges of the pandemic. My response was to address this isolation by creating a platform to foster meaningful connections between generations, particularly because I saw my own grandpa in a similar situation, unable to connect with loved ones.
So What:
I responded this way because I felt helpless being stuck at home in quarantine and wanted to do something meaningful, even if it was virtual. It was important not only for me but also for the elderly community and their families, as I witnessed firsthand the impact isolation was having on my grandfather. Although the idea had potential, the outcome was a mixture of success and failure. I learned a lot through the process, but ultimately, the initiative didn’t take off the way I had hoped. Organizing a sustainable effort like this requires much more coordination and involvement than I initially anticipated.
Now What:
This experience taught me that advocacy efforts need a committed team and clear structure to be successful. Moving forward, I will apply this lesson by ensuring that I build a solid foundation with dedicated people who share a passion for the cause. I also recognize the need to develop skills in team-building and leadership, particularly how to effectively motivate and inspire others to take action. Continuing to engage with advocacy work will give me the experience I need to succeed in future initiatives.
Alec, I love that you set this program up during such a challenging time! I remember feeling an overwhelming need to “do something” during the early pandemic period and can absolutely relate. I think you should give yourself a bit more credit on this – implementing a project that relies on both technology and consistent commitment from people with lives and schedules of their own is a big challenge. I think your point about sustainability here is a strong one. It is the toughest part of any volunteer program, from what I have seen. It has to be flexible, enjoyable, and fulfilling enough to keep people coming back and that is a tall order. Having a team, and constantly working to welcome others into that team, can help make sure there is a steady supply of volunteers. While I know this effort didn’t pan out exactly as you hoped, it sounds like it was a very useful lesson that will help you build more sustainable efforts in the future.
What
During the M1-M2 year, my learning community was very excited to partner with our assigned organization, which appeared to have robust services and the potential for collaboration. Unfortunately, throughout the academic year, there was significant turnover in the staff, causing our primary point of contact to be changed on multiple occasions. Additionally, there were limitations to in-person service opportunities post-COVID.
So what
As a group, our LC found ourselves restarting from square one with each new point of contact. This caused frustration in the relationship because we didn’t feel like we were positioned to make a meaningful contribution, and progress remained slow/stagnant during staff transitions. Our final project felt very different from the original ideas expressed at the beginning of the collaboration. The end result felt “convenient” rather than impactful which was very unsatisfying for someone who wanted to engage in meaningful advocacy.
Now what
Feedback to LC leadership throughout the process was our group’s main point of action. We were very open about the difficulties we faced while being patient and understanding with our community partner. I learned to be mindful of the season your potential community partners may be in and reflect on whether both parties have the capacity to meet expectations prior to establishing an official relationship! Although we may be excited to work with some organizations, they may not be ready to collaborate with us yet, and that is okay!
You make a really great point about reflection on both you and the community partner’s capacities and abilities to contribute meaningfully. I have been in a similar situation before where it felt like the project was almost forced rather than the result of me a community partner working towards a common goal. If both the person and the community partner are not 100% excited and committed to the project, it can lead to a lackluster result of what could’ve been a truthfully impactful project.
What
During my second year of medical school, I was able to work as the service and advocacy chair of the student run free clinic, and during that year it had come to my attention that there was a need for information on how to get free/reduced price prescription drugs. The leadership team was able to identify St. Vincent de Paul’s charitable pharmacy, and I was able to create information on directions to get to the pharmacy from the Healing Center, including directions and information on how to get there on public transit.
So what
I am glad that I was able to provide this information to patients at the clinic because it is vital for these people to have the information on how to get prescription drugs they otherwise would not be able to pick up/afford. Ultimately, the outcome of this was positive because we as the leadership team were able to identify a need and then swiftly create a solution to the targeted need.
Now what
There are several different lessons and skills that I took away from my work as service and advocacy chair, but in particular, I learned how to identify issues within an organization/barriers that people face when working with the organization. Looking forward to the current advocacy project, I am excited to utilize and grow these skills as I work to implement it.
There have been a number of times in the hospital that I wish I would have advocated more strongly for patients, especially with regard to discharge planning. I have worked with many patients facing housing insecurity, food insecurity, unsafe living conditions, and other challenges outside of the hospital; being in the hospital while receiving care was one of the only places they would avoid these issues. However, there came a time when each and every one of these patients needed to be discharged. I would often try my best to mention to the care team – sometimes my intern, other times my senior, and less frequently my attending – about my concerns about their safety after discharge. The answer was pretty much always the same, that social work was on the case and would come up with safe solutions. However, while I knew that the social work team was doing their best, oftentimes their solution was to send them out to whatever unsafe conditions the patients experienced before coming into the hospital. What I should have done was bring up my concerns again, perhaps elevate them to the attending level, but I was concerned about the power hierarchy of the hospital (and, surely, if my intern/senior weren’t concerned, I shouldn’t be concerned, right?). And so the patients were discharged; if history would repeat itself (as had been done many times previously, per chart review) these patients would likely find their ways back into the hospital, likely in part due to their unsafe conditions at home.
As I have progressed in my medical education, I have developed more trust in my own concerns and instincts to bring up these concerns more strongly and insistently – which I have seen result in safer discharge planning. This happened one time in particular on my peds AI, when my team was getting ready to discharge a patient whom I knew would not have safe living conditions at home, and upon my insistence, we waited a few days for the family to get living situations sorted out before she was discharged. I have learned that in order to advocate for my patients better in their realm, it is important for me to take a thorough history, to identify barriers to safe discharge, try to problem solve with the patient/family and social work, and if I still do not feel that safe planning is happening, that I should feel empowered to bring up my concerns with my superiors.