A Student-Led Change Effort in Health Systems Science Education: Development of a Novel Advocacy Guide

To the Editor: The quality and safety movement has brought necessary attention to health systems science as a third pillar of medical training alongside the basic and clinical sciences. The American Medical Association's health systems science framework 1 includes advocacy as a key health care process, underscoring the need for physicians to advocate for patients by improving access to care, using community and governmental resources, addressing health disparities, and influencing health policy. However, undergraduate medical education curricula have limited capacity for additional advocacy training. Student-run extracurricular organizations, such as Vanderbilt University School of Medicine's Social Mission Committee, provide an opportunity to fill this gap. The goal of the Social Mission Committee is to advance the social mission of our medical school by empowering students, faculty, and staff to actively partner with our communities to achieve health equity. One particularly successful initiative has been the creation and distribution of the Medical Student Advocacy Guide, a highly detailed digital resource that students can reference when caring for patients. The Guide includes information to help students navigate the health system (e.g., accessing interpreter services), guidelines on ways to approach patients with advanced psychosocial needs (e.g., patients experiencing homelessness), and local community resources to address social determinants of health (e.g., foodbanks). In January 2021, the Guide was presented to the clerkship-year class as a quality improvement project, with the aim of increasing students' health advocacy knowledge, skill, and engagement. It has since gained traction and is being incorporated in other areas of the institution, such as with Vanderbilt house staff, to generate sustained change. 2 The implementation of the Medical Student Advocacy Guide is a testament to how medical students can act as change agents to promote social medicine. The Guide is an accessible, low-cost, and durable resource that can be modified with future quality improvement cycles to meet the changing needs of students. We are fortunate to have built a coalition of stakeholders that includes administrators and physician champions who have willingly partnered with medical students to support student-led extracurricular change initiatives such as ours. Promoting student-led change efforts in health systems science education not only helps students see the immediate impact our education can have on patient care but also fosters our professional development as future physician advocates. Acknowledgments: The authors thank Heather Ridinger, MD, MHPE, for guidance and support throughout this process.