Energizing and Empowering Advocacy: A Qualitative Study of US Internal Medicine Trainees and Faculty Perspectives on Physician Advocacy

Clinical educators aiming to develop advocacy training have few established guidelines to follow. We conducted a needs assessment to explore perspectives of physician trainees and faculty to inform advocacy curriculum development and potentially facilitate increased advocacy engagement. We conducted 45-minute focus groups with 33 faculty (n = 16) and trainees (n = 17) from the Division of General Internal Medicine at a large US urban teaching hospital between September 2021 and February 2022. Interviews were audiotaped and transcribed on Zoom and de-identified prior to analysis. We used thematic analysis to identify key themes within a constructivist paradigm. Themes relating to participants' definitions of advocacy and their role as advocates included viewing advocacy as (1) supporting health and wellbeing in its broadest sense and viewing physicians as (2) in a position of power to advocate. Themes relating to perceived facilitators and barriers to advocacy engagement included (3) the lack of political education among physicians and (4) the need for interprofessional collaboration. Finally, themes relating to institutional support for advocacy included (5) the need for exposure to role models and (6) the importance of institutional culture. Physician participants reported that structured advocacy training combined with mentorship from professionals actively engaged in advocacy initiatives and a supportive institutional culture can enhance the perceived value of advocacy and empower engagement in it. Future studies are needed to explore interprofessional perspectives, as advocacy initiatives featuring interprofessional teams and supported by an institutional culture of advocacy are more likely to be successful.