Boston University

Boston University

Nicole Chamoy

Course last offered: Spring 2010

Page last updated: February 17, 2010

Spectrum of Physician Advocacy – Spring 2010

Faculty Advisor: Paul O’Bryan, Ph.D. Associate Dean of Student Affairs, BUSM

Student Facilitators
Nikki Chamoy, BUSM II,
Carolee Estelle, BUSM II,
Melissa Dowd, BUSM II,
Lisa Force, BUSM II,

Faculty and Guest Facilitators
Kathleen Conroy, M.D.; Medical Legal Partnership for Children
Kelley Saia, M.D.; Boston Center for Refugee Health and Human Rights
Jessie M. Gaeta, M.D.; Staff Physician, Boston Healthcare for the Homeless, Instructor of Medicine, BUSM
Chi-Cheng Huang, M.D.; Bolivian Street Children Project, Lahey Clinic Medical Center
Chen Kenyon, M.D.; Resident, Boston Combined Residency Program in Pediatrics
Lenny Lopez, M.D., M.P.H., MDiv; Internist, Brigham and Women's Hospital, Senior Faculty at Disparities Solution Center
Megan Sandel, M.D.; Pediatrician, Boston Medical Center, Medical Legal Partnership for Children
Pamela Tames, JD; Senior Staff Attorney, Medical Legal Partnership for Children
Robert Witzburg, M.D.; Associate Dean and Director of Admissions, Professor of Medicine, BUSM

Course Advisory Committee
Dan Dworkis, BUSM IV
Maryann Wilbur, BUSM IV
Chen Kenyon, M.D.; Chief Resident, Boston Combined Residency Program in Pediatrics
Paul O’Bryan, Ph.D., Associate Dean of Student Affairs, BUSM
Benjamin Siegel, M.D.; Professor of Pediatrics, BUSM
Rachel Stein, BUSM IV
Robert Witzburg, M.D.; Associate Dean and Director of Admissions, Professor of Medicine, BUSM

Course Sponsor: Public Citizen’s Health Research Group

Course Description
This course will provide a forum for medical students to explore and develop
their understanding and perception of:

  1. The unique roles and responsibilities of the physician in society.
  2. The various opportunities for greater involvement in community
    development, health policy and global health.
  3. Where their respective interests can help define their path in
    medicine and pursuits beyond medical school.

In addition, students will acquire knowledge about resources available to address certain patient needs that can be applied in their clinical training at BUSM and beyond. The class will also foster an environment where students will find inspiration and support from others in their advocacy pursuits.

The course has the following objectives:
-To develop a sense of what physician advocacy is and how it can be applied to direct patient care.
-To extrapolate the acquisition of knowledge that occurs in medical school into beneficial societal effects and to understand advocacy efforts at a more personal and tangible level.
-To recognize that advocacy is linked to the mission of medicine and that some level of patient advocacy is the responsibility of the physician as a medical professional.
-To gain a greater awareness of the delicate balance a physician must find in his or her roles as a scientist, a healer, and an advocate.
-To develop an appreciation of the health disparities that exist at the community, state, national and global level and the consequent need for physicians to act as advocates.
-To recognize the local trends in health outcomes, the sources of disparity, and potential interventions to ameliorate these inequalities.
-To translate patient information and community trends into data that can help inform health and public policy making.
-To distinguish domestic health agendas from global initiatives as well as appreciate global health disparities in the context of the human rights movement.
-To encourage the cultivation of individual motivation and preservation of ideals as students proceed through their clinical training.
-To increase awareness of the patient advocacy resources at Boston Medical Center.
-To recognize the unique approach of our hospital and use it as a model for our future practices.
-To expose students to a range of opportunities for involvement in advocacy and career paths.

Welcome to The Spectrum of Physician Advocacy! We are excited to journey with you on a two-month-long experience investigating the possibilities for creating systemic health care improvement. The Spectrum of Physician Advocacy was created five years ago by four fourth year students and will be co-taught this year by four second year students who participated in the course last year, along with a number of accomplished and inspiring BUSM faculty and guest speakers. We hope to introduce you to the various responsibilities and opportunities of physicians to advocate for individual patients and to take active roles in greater healthcare debates. During the course you will be exposed to a broad range of routine and systemic advocacy topics including medical-legal collaboration, community-oriented health care, translating patient care experience into good health policy, and global health equity. By the end of the two months, we hope that you will:

  1. have a better understanding of current topics in health care improvement
  2. understand the unique capital that physicians can contribute to these discussions
  3. have developed a foundation of basic advocacy tools
  4. have made connections with other students and faculty who will provide support and encouragement as you pursue your career as a physician advocate.

The course will meet a total of eight times (once a week), and will include both seminar/discussion components as well as an advocacy assignment crafted specifically around a health care related issue of importance to you.
This course is an opportunity to deepen your understanding of the interplay between social situations and health and how you as a physician can work to uncouple disadvantages from adverse health outcomes. It is also an opportunity to connect with faculty members who can serve as mentors throughout your medical school careers.

We would like to thank Peter Lurie from Public Citizen for his continuing interest in this class and its mission. We also thank Bob Witzburg and Ben Siegel for all of their support and guidance throughout the process. Special thanks to Paul O’Bryan, Phyllis Carr, Liz Gallagher, Maryanne Raposo, and Ana Bediako in the OSA for adopting the course into their department and lives. Thank you to Sharon Levine for her excitement about expanding the mission of the course and to Catherine Dube and Angela Jackson for their help in doing so. We offer a final thanks to Chen Kenyon, Rachel Stein, Dan Dworkis, and MaryAnn Wilbur, as well as Leah Hartford, Lindsay Miller and Lie Tjoeng whose leadership has been invaluable in the continuing development and success of this course.

We would like to dedicate the 2010 Spectrum of Physician Advocacy Syllabus to Babur Khalique, one of the 2009 leaders of this course. Babur's passion for advocacy and life are inspiring and we hope to live up to his dedication to making this world a better place.

The Schedule
There will be 8 sessions over the course of 10 weeks, with no class during spring break. Sessions will take place from 4:30-6:30pm on Wednesday evenings, unless otherwise noted. Sessions will be held in the medical school as follows:





Required readings:


Wed 2/3/10


Introduction – The Case for Advocacy

Kakoza. The Challenges of Patient Advocacy on the Wards


Wed 2/10/10



Individual Advocacy – The Medical Legal Partnership for Children

Zuckerman. Why Pediatricians need Lawyers to Keep Children Healthy


Wed 2/17/10


Community Advocacy – The Social Context of Health

Marmot. Social determinants of health inequalities


Wed 2/24/10


Global Advocacy – Immigrant and Refugee Health

1. Crosby. Seeking Asylum from Torture: A Doctor’s View.

2. National Association of Community Health Centers Fact Sheet 2006.


Wed 3/17/10

Seminar Rm

Global Advocacy – Understanding the Need

Shaywitz. Global health: A chance for Western physicians to give – and receive


Wed 3/31/10


Community Advocacy – Acting with Responsibility

Montauk. The Homeless in America: Adapting Your Practice


Wed 4/7/10


Public Health Advocacy

Woolf. The 2009 Breast Cancer Screening Recommendations


Wed 4/14/10


Conclusion –
Go Forward, Move Ahead

No Required Reading

*NOTE: Wed 3/3/09 and Wed 3/10/10 there will not be class

Field Trip
This year, the class will have the opportunity to tour one of the Boston Healthcare for the Homeless Program's facilities. Jean Hawkey Place is a state-of-the-art facility located right in the South End. It is the first and the largest respite program for homeless individuals in the United States. It is the primary referral location for that homeless individuals are discharged from Boston hospitals, but still need complex care. The date for the field trip is TBD.

The Advocacy Assignment
Over the next two months, we expect every student, either as an individual or with a group, to undertake a small advocacy assignment. Each week several students will be assigned to give two to three minute presentations on what they did for their assignment. The assignment should not consume more than two hours of your time and is meant to supplement your learning. Examples of previous student projects are listed below.

- Pamphlet to educate voters on Democratic candidates' positions on health care
- Marathon to raise money for BMC
- Medical Haitian-Creole class
- Universal health care panel
- Op-ed on food insecurity and the Farm Bill
- Pamphlet to educate voters on Republican candidates' positions on health care
- Project Trust (rapid HIV test) manual
- Korean domestic violence group
- Congress calling campaign for the African Health Capacity Investment Act
- Prison Creative Arts project – bringing art into prisons and juvenile facilities, helping artists who were in prison find jobs and galleries
- Medical and Legal Partnership for Children – clinic and provider education at the Dorchester House with a focus on housing
- BMC food pantry's demo kitchen workshops – educational cooking demos for patients with diabetes mellitus
- Volunteering with the Boston Center for Refugee Health and Human Rights
- Pamphlet on Advocacy resources and programs to become involved in, for insertion in BUSM applicant brochure