RESIDENTS’ PERSPECTIVE

Health advocacy in a competency-based curriculum: The emerging

role of global surgery

R. Christopher Doiron, MD

Department of Urology, Queen’s University, Kingston, ON, Canada

Cite as: Can Urol Assoc J 2016;10(3-4):82. http://dx.doi.org/10.5489/cuaj.3771

among surgical residents training in North America is at an

all-time high. Herein lies a golden opportunity to align the

ith the introduction of the CanMEDS program by

the Royal College of Physicians and Surgeons of

Canada (RCPSC) in the 1990s, a new compre-

interests of our trainees with the competencies expected

of them; what better way to learn and gain competence in

health advocacy than spending time providing care to the

world’s most poor and marginalized?

hensive framework for medical education was introduced.

The program outlined seven physician roles: medical expert,

scholar, communicator, collaborator, health advocate, man-

ager, and professional. While recognizing the importance of

the broader role the physician plays in our communities and

health systems, the program required that medical trainees be

formally evaluated in each of these domains. The CanMEDS

roles have now long formed the basis for undergraduate

and postgraduate medical curricula and are well embedded

within the lexicon of modern medical education.

Formalizing the CanMEDS roles — defining them, inte-

grating them into curricula, and evaluating them — was not

straightforward. The role of health advocate has been a particu-

lar challenge and much literature exists describing the hurdles

faced in dealing with health advocacy in residency training.

We know from a 2007 survey that Canadian urology residents

lack awareness of its mere existence in the framework and there

was a deﬁciency of formal health advocacy opportunities and

mentorship within our institutions. Although there have been

some modest improvements, health advocacy has remained

somewhat of an enigma within our residency training programs.

This has undoubtedly led to its marginalization within medical

curricula, particularly in residency, where the workloads of

patient care dominate residents’ day-to-day and the academic

burden of fulﬁlling the medical expert role weighs heavily.

With another metamorphosis of our Canadian medical

education system on the horizon — competency-based

medical education (CBME) — perhaps the time is right to

revisit how to address these more challenging physician

roles. It certainly cannot be that the importance of compe-

tency in health advocacy among practicing urologists has

diminished. One could argue instead that our patients, com-

munities, and even our country cannot afford us to continue

to treat it as an afterthought.

A surgical elective in a low- and middle-income country

could represent the quintessential experience in health advo-

cacy for a urology resident. Participants in global surgery work

are exposed to the crippling problem of poor access to basic

medical care and must grapple with troubling questions of

global health equity. The role of surgery in public health and

health policy are also explored. Beyond the role of health

advocate, residents are exposed to a broader scope of uro-

logic pathology, challenged to communicate often in foreign

languages or with the use of a translator, and forced to rely on

their history-taking and physical examination skills with mini-

mal resources to perform investigations and imaging studies.

Furthermore, it is an exciting time in the ﬁeld of global

surgery. While fellowship opportunities in global surgery

are sprouting up at academic centres across North America,

the work of the Lancet Commission in Global Surgery has

helped surgery elbow its way onto the global health agenda.

In fact, a case study on the commission’s work alone would

be a welcomed exercise for any student of health advocacy.

Although the Lancet Commission lacked both urologic and

Canadian representation, as the ﬁeld of global surgery con-

tinues to forge ahead, there is great opportunity for urologists

and urology residents to heed the tide and get involved.

Some have advocated for a global surgery elective as

mandatory in surgical training programs. Perhaps a bit

hyperbolic to discuss as mandatory, it at the least warrants

our consideration as an excellent opportunity in health advo-

cacy and should be supported as such by our institutions for

those residents with interest. With CBME on the way, it also

represents a practical and clear-cut avenue for achieving

competency in health advocacy.

Competing interests: The author declares no competing ﬁnancial or personal interests.

Despite the difﬁculties with formalized training in health

advocacy, enthusiasm for advocacy issues among trainees

is unprecedented, particularly in the ﬁeld of global health.

Recent literature has suggested that interest in global surgery

Correspondence: Dr. R. Christopher Doiron, Kingston General Hospital, Kingston, ON, Canada;

chris.doiron@queensu.ca

CUAJ • March-April 2016 • Volume 10, Issues 3-4

2016 Canadian Urological Association