Can Resident Advocacy Work Be Characterized to Inform Better Training?

The findings: Contributing to the ever-evolving landscape of resident advocacy education, researchers from Children's Hospital of Philadelphia studied the ways in which residents participate in advocacy and how their participation has changed over time. They characterized findings into four types of advocacy:

• Directed agency, in which pediatric residents determine needs and lead health interventions on parents' behalf
• Shared agency, in which stakeholders determine their needs, and pediatric residents fulfill or support the health interventions
• Directed activism, in which pediatric residents determine stakeholders' needs, then lead and support systems-level action
• Shared activism, in which stakeholders determine their needs and engage in systems-level action with support from pediatric residents.

Residents engaging in activism advocacy often worked in larger, collaborative teams that focused on the sustainability of a project after the resident's departure. Agency advocates typically had smaller teams with one mentor focused on health system issues and quality improvement.

Residents' idea of advocacy work also shifted over time, beginning with personal experience or connections to patients, families, and colleagues, and moving toward a broader, community-based role. The social and political climate also began to affect how residents considered their advocacy work and their roles as pediatricians.

Why it matters: Pediatric patients are a vulnerable population in that they cannot voice their own opinions or vote in their favor. Understanding how and in which ways residents advocate can help educators design an advocacy curriculum that has the most beneficial impact. Effectively characterizing different types of advocacy will also help educators identify which skills their residents may need to supplement or support to achieve personal and professional goals.

Who conducted the study: Noreena Lewis, JD, co-director of the Community Pediatrics and Advocacy Program at CHOP, and Beth Rezet, MD, vice director of the Pediatrics Residency Program, contributed to this study alongside Hannah Anderson, MBA, a researcher in the Department of Pediatrics at CHOP and the University of Pennsylvania Perelman School of Medicine.

How they did it: Researchers collected completed, deidentified advocacy work projects with self-reflection documents from pediatric residents over a span of eight years (2013-2021). They analyzed a total of 45 projects alongside 45 reflections to better understand residents' perspectives on their work.

Organizing data in the University of British Columbia health advocacy evidence-based framework, researchers analyzed qualitative data and constructed findings based on common themes. Residents who participated in shared forms of advocacy noted learning opportunities in "partnering," "evaluating," and "planning," whereas residents who leaned toward directed forms of advocacy reflected on "leading," "presenting," and "intervening." This indicates differences in learning experiences based on advocacy type as well as mentorship style.

Quick thoughts: "This study was incredibly important and meaningful to us because we were able to highlight that our pediatric [residency] learners are doing a lot of advocacy work and contributing to patients and communities," said Lewis and Anderson. "Peer mentorship, community mentors, and diverse mentorship teams were critical to so many advocacy projects. This research also demonstrated that the way residents engage in advocacy is evolving over time, and it's critical that educators pay attention to trends and regularly seek feedback from their learners."

What's next: Future research will seek to understand advocacy work from the residents' perspectives to identify both positive benefits and potential challenges and influences. Additionally, further studies could analyze possible outcomes related to the different types of resident advocacy work. Educational and training programs should better support the important work of resident advocates by recognizing areas that may need to be supplemented based on the type of advocacy they participate in.

Where the study was published: The study appears in Pediatrics.