Looking forward, medical students hone advocacy skills

Four medical students in white coats huddle quietly outside a senator’s office at the Capitol in Austin. It’s an impromptu cram session, but they aren’t reviewing histology or lymphatics. One is thumbing through a staple-bound directory of legislators, looking for the senator’s committee appointments; others are reviewing bullet points on a flyer. One checks her watch: Four minutes to 10.

“Should we go in now?” she asks.

“Wait,” another says. “We’re early.”

The four medical students drove in from the Texas A&M Health Science Center (TAMHSC) College of Medicine’s Temple campus to attend First Tuesday, a health advocacy event organized by the Texas Medical Association (TMA), the largest state medical association in the country. They, along with more than 150 medical students from across the state, are here to meet with state legislators to discuss funding for graduate medical education (GME), the residency training all medical school graduates must complete before practicing independently.

Health care administrators predict a massive physician shortage in the next decade as baby boomers retire. Medical schools have been rapidly increasing incoming class sizes to address it, but residency slots aren’t keeping pace with the growth. And more than 5 percent of qualified medical school graduates nationwide failed to secure a residency at all.

At 10 on the nose, they open the door and file in.

Although these students will focus exclusively on the GME issue, residency shortages are just the first challenge they face. The Centers for Disease Control and Prevention estimates 75 percent of current U.S. health care dollars are spent managing preventable diseases, and the average per-patient expense is $8,000 per year, compared to an average of $3,000 per year in other developed countries. Add to that the planned injection of 30 million currently uninsured citizens into the insurance pool in less than a year, and many see a system in crisis.

Training Doctors to Lead

Medical education has long focused on training future doctors to think critically, examine symptomatic evidence and plan a response. For educators like Dr. Ruth Bush, a vascular surgeon and the associate dean for academic affairs at the TAMHSC-College of Medicine’s Round Rock campus, it’s time to apply that critical thinking model to our nation’s health care system.

“Our goal is not to prescribe a specific remedy and ask our students to adopt it,” Dr. Bush said. “It’s to show students the issues and educate them in how they can become involved in developing the solutions. We call this the CARE model. In all aspects of their medical education, we show students how to ‘critically appraise relevant evidence.’ They need the same training in how to address the issues facing American health care.”

To that end, the college is preparing to roll out several new initiatives at the medical school’s third- and fourth-year campus in Round Rock. It is home to the college’s first residency program in preventive medicine and has presented an ongoing public lecture series on transforming American health care. Dr. Jim Donovan, the campus’ new associate dean for clinical integration and practice transformation, will help the campus assess how to prepare medical students for the changing landscape of American health care, including a variety of new course options.

First up is an elective course on health advocacy, a growing trend among U.S. medical schools. The TAMHSC College of Medicine’s course partners fourth-year medical students with organizations that develop and propose solutions for public health problems; so far, students piloting the program have focused on working with specialty and advocacy groups in the areas of mental health and pediatrics. For those taking the elective during the state legislature’s biennial sessions, First Tuesday will play a central role.

“By including health advocacy in the curriculum, we encourage students to think on a larger scale,” Dr. Bush said. “It helps them to think about the future of their profession and how they can contribute to it.”

This year, the TAMHSC-College of Medicine was recognized for sending the largest contingent of students to First Tuesday of any Texas medical school. For Cecilia Benz, a second-year student and campus TMA president, the strong presence of fourth-year students, or “M4’s,” was significant. “Our M4’s are done, they’ve matched, and they still decided to invest their time and effort into helping us out, helping to get GME funding passed,” Benz said. “We’re really grateful that they showed up.”

Dr. Bush also hopes to extend health advocacy training to all medical students. “The basics include finding information regarding pending legislation, identifying who your elected representatives are and how to interact with them, developing an elevator speech [a brief synopsis of a position that can be delivered in a minute or two] and a fact sheet on an issue, and other advocacy communication skills,” she said.

Making an Impact

If you’re looking for a model for the medical student/health advocate of the future, TAMHSC-College of Medicine student Collin Juergens is a good place to start. He’s one of a handful of students from the college who teamed up with students from Baylor College of Medicine earlier in the year to develop a proposal to have drivers’ licenses marked to indicate whether a person has established an advanced directive in the event of an emergency. If student delegates approve the measure at the May meeting of the TMA, it will be passed to the full membership; if approved there, it could be presented for potential legislative action.

“The eventual outcome might be that we have a little advanced directive symbol on our driver’s licenses to help encourage the public to think about that and for medical providers to be aware of the patient’s wishes. And that will have come from Texas A&M and Baylor students,” Juergens said.

For some initiatives, the chain reaction need not stop there: An endorsement by the American Medical Association (AMA), which can gain needed momentum through a TMA endorsement, could lead to federal legislation, giving an idea launched by medical students the possibility of becoming the law of the land.

Third-year student and class president Gabriel Axelrud, who attends the TAMHSC-College of Medicine at Round Rock, took the campus’ passion for health advocacy straight to the AMA. Axelrud has co-authored a resolution with five other medical students, including AMA Medical Student Section Chair-Elect Atul Nakhasi of the Johns Hopkins University School of Medicine, to ask the AMA to endorse and develop guidelines for health advocacy as part of the U.S. medical curriculum. The student section adopted it, referring it to the full AMA for consideration. If the AMA leadership agrees to take action, the trend toward preparing medical students for health advocacy will spread even more rapidly.

But that would be getting ahead of ourselves. The real purpose of First Tuesday is to cultivate a sense of community and agency among students. TAMHSC-College of Medicine first-year student Dane Pawlowski said the spirit of collaboration had indeed made an impression.

“You have all these students from these different places,” he said afterward. “But you don’t think of it when you’re there. They’re all future doctors, and they’re all there to help each other out.”