Faculty Support for Advocacy Is Key to Training the Next Generation of Pediatrician-Advocates.

Abstract

We are pleased to see a focus on advocacy in the hospital setting described by Winthrop et al in the October 2021 Hospital Pediatrics perspectives article, “Training the Next Generation of Pediatrician-Advocates: A New Focus on the Inpatient Setting.” We agree that pediatric residency training would benefit from advocacy teaching in this setting. Such training can be modeled after the advocacy curricular resources developed for pediatric hospital medicine. These resources include: (1) competency-based goals and objectives for the advocacy rotation that map to pediatric subspecialty entrustable professional activities, developed by the curriculum committee of the Pediatric Hospital Medicine Fellowship Program Directors Council; and (2) specific knowledge, skills, and attitudes in advocacy as defined by the 2020 Pediatric Hospital Medicine Core Competencies.1However, faculty development in advocacy is necessary but not sufficient to allow for advocacy training and curricular development in the inpatient setting. Inpatient faculty must also be given the time, resources, and support to perform and teach advocacy. This can only happen if advocacy scholarship is congruent to traditional scholarship, including both research and medical education. We propose the following additional faculty needs to establish integration of advocacy in the hospital practice setting: Adoption of advocacy portfolios: Clinician-researchers generate scholarship to benefit patients and populations in the form of peer-reviewed grants and publications. Clinician-educators have gained support for scholarly activities and faculty promotion in medical education through the development and application of educator portfolios. Recognition of advocacy as a scholarly pursuit can only be achieved through the dissemination and widespread adoption of advocacy portfolios (APs).2 APs supplement the curriculum vitae to highlight how advocacy can be held to the same rigorous scholarly standards as traditional scholarship. Recognition of advocacy and APs in the academic promotion process will allow those interested in pursuing an advocacy scholarship to be successful in obtaining the time and resources necessary for practice. A national group of pediatrician-advocates has developed the first standardized AP template along with the American Academy of Pediatrics Community Pediatrics Training Initiative.3Advocacy recognition within the Pediatric Hospital Medicine Board certification process: The American Board of Pediatrics (ABP) has proposed a pediatric subspecialty entrustable professional activity focused on population health. Additionally, “advocacy and leadership” is a content domain for Pediatric Hospital Medicine Board certification. Despite this, the ABP has not recognized advocacy as a form of scholarship and “work product” allowable for pediatric subspecialty fellowship completion and subsequent board certification, even it if meets the Glassick criteria for scholarship.4 Lastly, allowing physicians to submit advocacy projects for maintenance of certification credit would greatly assist in recognizing the role of physician advocacy in improving population health.Advocacy will gain congruence in academics through a simultaneous bottom-up and top-down approach: faculty use of APs as developmental and promotional tools, along with recognition and support from medical school leadership and the ABP. Only if these criteria are met will faculty be recognized for scholarly advocacy activities, thereby supporting the time, resources, and funding necessary for teaching such practice to the next generation.