Building a Community-Centered Public Health Advocacy Program for Students
A Minnesota-based public health advocacy fellowship trains medical students in community-centered advocacy with lessons relevant beyond medicine, practical to most STEM fields seeking to train students in advocacy skills.
Within and beyond the medical community, the (often unearned) public trust, social capital, professional privilege, and socioeconomic status that physicians enjoy requires their reciprocal involvement in and advocacy against public issues affecting societal health. Many medical schools, residencies, fellowships, and professional medical societies have thus called for the development of advocacy training across levels of medical education.
In our article titled “Building a Community-Centered Public Health Advocacy Training Program for Medical Students,” my colleagues and I describe the development, evolution, and evaluation of the innovative Dr. Pete Dehnel Public Health Advocacy Fellowship, a medical student training program of the Twin Cities Medical Society (TCMS). This fellowship aims to help medical students build the knowledge, skills, and commitment necessary to engage in public health advocacy throughout the course of their careers. Though the program is geared towards medical students, the principles of community-centered advocacy are transferable to not only the allied health fields (like nursing or public health), but also to any and all STEM professionals and students who wish to engage in advocacy.
Each of the authors has participated in the fellowship in different capacities – myself as a previous medical student advocacy fellow; Dr. Surapaneni as a physician-mentor and advocate; Dr. Phinney as the fellowship evaluator, and Ms. Krapek as a fellowship staffer and previous CEO of TCMS. As four individuals with unique experiences and skills that intersect along the lines of public health and community advocacy, we seek to highlight how the fellowship incorporates a non-hierarchical, cohort-based learning model adaptive to real-time feedback, thereby allowing the curriculum to respond to the changing needs of students and the local community.
☆ Community-centeredness and a non-hierarchical cohort-based learning model teach the knowledge and skills necessary to practice advocacy.
Each spring, TCMS invites University of Minnesota medical students to apply for the 9-month Dr. Pete Dehnel Public Health Advocacy Fellowship. Accepted students are paired with a local physician-mentor with similar public health interests. The student and mentor work together to identify a community-oriented public health issue to address over the duration of the fellowship year.
Community-centeredness is a core principle of TCMS (as an organization) and the fellowship. This philosophy states that an effective physician-advocate must partner directly with the community impacted by the issue that the physician is addressing. By centering the affected community and their lived experiences in their advocacy work, the physician can act in a culturally humble manner. This way, an anti-racist, health equity-based lens is adopted. This concept is actively present in the fellowship by recruiting physician-mentors who actively partner with affected communities and student trainings that focus on teaching to center communities in advocacy. This is also supported by curricular elements that teach to bypass the traditional hierarchical structures of medicine (ie, from physician to resident to medical student) so fellows of the program (who are themselves medical students) can learn to view non-medical partners and community members as equals in the advocacy process.
The fellowship’s curriculum thus focuses on teaching both the principles of community-centered physician advocacy and the skills typically employed by advocates in public settings – such as speaking with legislators, writing letters to the editors, and organizing advocacy meetings – and by inviting local community leaders and legislators to teach the grassroots and legislative lenses of advocacy. The curriculum is also enhanced by the cohort-learning model, where fellows progress through the 9-month curriculum as a group to promote peer-to-peer learning.
☆ Ongoing developmental evaluation allows for program adaptability.
To inform the fellowship’s evolution, TCMS partnered with Rise Research, an independent research and evaluation organization to conduct ongoing developmental evaluation of the fellowship. By utilizing rapid cycle feedback from current and past fellows, the program contains a unique aspect of adaptability that allows course changes during and at the start of each fellowship year.
From our analysis, participants of the fellowship have reported an overwhelmingly positive impact on their current training and future commitment to advocacy. Fellows also perceived gaining significant growth across 3 measures (which include: 1) knowledge of how to engage in advocacy, 2) skills in connecting with advocacy communities and communicating with public health officials, 3) interest and motivation to continue advocacy as physicians).
Below, we highlight some of the changes made to the curriculum based on developmental evaluation over 3 years (2018-2021):
- Fellows valued peer-to-peer relationships and wanted relation-building opportunities → Several new community-building activities established between peers and mentor/mentees
- Fellows wanted to understand how personal wellness and advocacy work can integrate cohesively → Added a session where physician-mentors explain how to integrate advocacy into life in a manner that enhances wellness rather than burnout
- Requiring completion of a tangible advocacy project by the end of the fellowship left fellows feeling “task-focused” → Shifted to “personal achievement-focused” curriculum where fellows set goals and activities for the year that are personally meaningful
☆ Public health advocacy programs should adopt community-centered models of teaching.
To practice public health advocacy through an anti-racist, health equity-based lens requires understanding that physicians must work in conjunction with and respect the lived expertise of the communities they hope to serve. The Dr. Pete Dehnel Public Health Advocacy Fellowship aims to teach medical students (ie, future physicians) this concept through a program-wide culture of responsibility, humility, and responsiveness to feedback. Programs that approach physician advocacy training similar to traditional medical education risk adopting an “ivory tower” approach that replicates existing power hierarchies and inadvertently focuses on physician accomplishments instead of community needs. Community-centered models of advocacy training offer a compelling way to enable physician advocacy to center community needs, elevate voices of those impacted by inequities, and foster innovative system change driven by community wisdom.
Through our writing, we hope that other upcoming or ongoing advocacy training programs, whether within medicine, the allied health fields, or beyond, will find knowledge and inspiration to enhance or change their own curriculum.
To learn more about the structure and curriculum of the Dr. Pete Dehnel Public Health Advocacy Fellowship, a program of the Twin Cities Medical Society, read our research report here.
Laalitha Surapaneni, MD, MPH, is a board-certified practicing internal medicine physician with a public health degree from Johns Hopkins. Her areas of interest are health and equity impacts of climate change, and how physicians can advocate for climate policies that promote human and planetary health. As a physician climate advocate, Dr. Surapaneni has testified numerous times to the Minnesota state legislature about the public health impacts of climate change. Dr. Surapaneni is also a current national board member of Physicians for Social Responsibility and a Public Voices Fellow of the OpEd Project, in partnership with the Yale Program on Climate Change Communication.
Robin Phinney, PhD, is the President of Rise Research, a research and evaluation firm dedicated to helping communities thrive. She received her doctorate in Public Policy and Political Science from the University of Michigan and has published widely on social programs and policy. In her current work, Robin leads projects focused on human services, public health, and criminal legal systems, as well as innovation in the public sector. She has worked with a diverse array of stakeholders both nationally and across Minnesota and is currently a Master Contractor with the State of Minnesota.
Annie Krapek, MPH, is the former CEO of Twin Cities Medical Society, where she led the Dr. Pete Dehnel Public Health Advocacy Fellowship program. She received her Master of Public Health from the University of Minnesota. Annie is passionate about providing professionals with tools and opportunities to advocate for healthy and equitable communities.
- Sruthi Shankar, MD, is a recent graduate of the University of Minnesota Medical School and a previous fellow of the Dr. Pete Dehnel Public Health Advocacy Fellowship. She will be an incoming resident with the University of Minnesota General Surgery program where she hopes to continue researching and writing about social determinants of health, health equity, and health advocacy.
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