Educational needs assessment for health advocate role in family medicine residency training in Turkey: A Delphi study.

European Journal of General Practice 2024, VOL. 30, NO. 1, 2386284 https://doi.org/10.1080/13814788.2024.2386284 Research Article Educational needs assessment for health advocate role in family medicine residency training in Turkey: A Delphi study Meral Demirörena and Duygu Ayhan Başerb Department of Medical Education and Informatics, Hacettepe University Faculty of Medicine, Ankara, Turkey; bDepartment of Family Medicine, Hacettepe University School of Medicine, Ankara, Turkey a KEY MESSAGES • The competencies expected for the health advocacy role of the family physicians show commonalities with the family physicians’ ‘professional’, ‘expert’ and ‘leader’ roles. • It is important to longitudinally integrate health advocacy training into the family medicine residency training core curriculum at the national level. ABSTRACT Background: Health advocacy (HA) involves purposeful actions to inform, mobilise, and organise activities to address social determinants of health affecting individuals or communities. It is a fundamental component of medical practice, deemed mandatory by professional and educational bodies. Therefore, including health advocacy training in pre- and post-graduate medical education is crucial. Objectives: In this study, we aimed to determine the need for HA training for family physicians (FPs) based on expert opinions. Methods: We conducted a modified Delphi study with 105 academic experts and active FPs to explore HA training needs. Using a three-round technique, experts first answered five open-ended questions on HA competencies, teaching and assessment methods, learning environments, and integration in residency training. In the second round, statements from the responses were rated on a 5-point Likert scale, in the third round, statements below the 85% consensus level were revised and re-evaluated. Results: The panel consisted of 41 experts (33 academicians, 8 practitioners) who accepted the invitation and completed the study. At the end of the three rounds, consensus was reached on 38 statements for HA competencies, 15 for teaching methods, 8 for assessment methods, and 20 for integration for HA training. Conclusion: Competencies for the HA role are very broad in perspective and show commonalities with the FPs’ ‘professional’, ‘expert’ and ‘leader’ roles. Longitudinally integration of the HA training into the national ‘Family Medicine Residency Training Core Curriculum’ through participatory processes and training of FM trainers in HA is strongly recommended. Introduction Health advocacy (HA) is purposeful action by informing or initiating, mobilising and organising activities on behalf of or with them to create change towards the social determinants of health that adversely affect the health of individuals or communities [1]. Today, HA is accepted as a fundamental component of medical practice and is considered mandatory by professional ARTICLE HISTORY Received 6 April 2023 Revised 20 July 2024 Accepted 25 July 2024 KEYWORDS Health advocacy; Delphi technique; family medicine; residency training and educational bodies. In this context, it is important to include HA training in pre- and post-graduate medical education. HA training is also important in terms of the social accountability of medical schools. The Accreditation Council for Graduate Medical Education [2] integrated HA principles into the program requirements. The Physician Charter of the American Board of Internal Medicine, and the Royal College of Physicians CONTACT Duygu Ayhan Başer Supplemental data for this article can be accessed online at https://doi.org/10.1080/13814788.2024.2386284. © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. 2 M. DEMIRÖREN AND D. A. BAŞER and Surgeons of Canada also supported this commitment [3, 4]. Family medicine (FM) is a specialty that provides patient-centered and continuous primary health care to individuals and families regardless of age, gender or disease. This approach not only enhances the overall healthcare experience but also fosters a collaborative and empowering relationship between healthcare providers and patients. A vital aspect of health advocacy, especially in the realm of general practice (GP), is the concept of quaternary prevention. Quaternary prevention focuses on preventing the harmful effects of medical interventions and avoiding unnecessary medicalisation. In the Family Medicine Tree published by the European Regional Branch of the World Organisation of Family Doctors (WONCA Europe) [5], ‘community oriented’ is defined as reconciling the health needs of individual patients with the health needs of the society in which they live, in a balance in terms of the use of existing resources. The HA role of family physicians was also mentioned in CanMEDS Physician Competency Framework [6] and The Canadian Medical Education Directives for Specialists – Family Medicine Competency Framework [7]. In Turkey, HA is also not included in the professional competencies of the Turkish Association of Family Physicians Qualification Board [8]. In the FP framework education program developed by the specialty association, although HA was mentioned among the Family Physician’s (FP) characteristics, it is not included among the key competencies defined for FP, but community orientation is mentioned. Firstly, the training needs for the HA role should be contextually determined. Needs assessment will guide the development of the HA training program and the design of teaching and assessment processes. In this study, we aimed to determine the need for HA training for FPs based on expert opinions at the national level. Research questions are defined: 1. 2. What are the expected competencies of the Family Physician for the role of health advocacy? How can HA competencies be gained and assessed in Family Medicine Residency Training? How can HA training be integrated into Family Medicine Residency Training? Delphi process Selection of expert panel Participants in the expert panel in the Delphi study are expected to be competent, sufficient and heterogeneous in their field [11, 12]. Definition of an expert within the scope of the research: • • • • • • FM academics: Faculty members involved in FMRT FPs who have been working in Family Health Centres for at least 2 years FPs who have been working actively in the Turkish Association of Family Physicians and Turkish Medical Association – Family Medicine Specialty Board Experts working in the relevant departm (...truncated)