494 - State of Affairs for Advocacy Education in Pediatric Hospital Medicine Fellowships Across the United States

Poster Number: 494
Publication Number: 494.124

Emily Hopkins, Texas Children's Hospital, Houston, TX, United States; Michelle Lopez, Baylor College of Medicine, Houston, TX, United States; Claire Bocchini, Baylor College of Medicine, Houston, TX, United States; Heather Haq, Baylor College of Medicine, Houston, TX, United States

Background: The Accreditation Council for Graduate Medical Education (ACGME) has well-defined advocacy milestones largely focused on outpatient experiences. The hospital inpatient setting offers a unique opportunity for advocacy.

Objective: This study aims to assess the current educational landscape for advocacy training within Pediatric Hospital Medicine (PHM) fellowships by surveying PHM Program Directors (PDs) and fellows on educational offerings, perceived needs, and barriers.

Design/Methods: We conducted a cross-sectional survey of PHM PDs and fellows from ACGME-accredited programs in the summer of 2022. Surveys were developed using content experts and literature review, and underwent a piloting and validation process with PHM educational leaders and fellows from other pediatric subspecialities. We performed summary statistics on quantitative data and compared PD and fellow categorical responses using the Chi-squared test. We used a content analysis approach to identify emergent themes from free responses.

Results: Response rate was 37 of 65 (56.9%) PDs and 60 of 101 (59.4%) PHM fellows. Over half (59%) of PDs reported their programs offered a form of advocacy education with the majority of those (77%) being optional. While only 40% of fellows reported having an advocacy elective available, 70% reported if an elective was offered they would participate. In terms of confidence in advocacy skills, 40% of fellows rated themselves as either not at all or slightly confident. The top 3 barriers to advocacy education identified by PDs and fellows respectively were lack of faculty expertise (67%, 37%), time in curriculum (58%, 38%), and lack of faculty mentorship (42%, 37%). Overall, 59% of PDs, and 75% of fellows believed advocacy education was very or extremely important for pediatric hospitalists (p-value 0.098).  Qualitative data revealed themes related to viewing advocacy as central to pediatric hospitalists’ roles and support for inclusion of advocacy training in PHM fellowships, with more in-depth training opportunities for fellows who express interest.

Conclusion(s): Based on our national survey results, advocacy education in PHM fellowships is desired by program leaders and fellows but offerings are limited. Several barriers were identified by PDs and fellows, with faculty expertise being identified as the greatest barrier. Continued insight from stakeholders in the inpatient setting is imperative to address next steps. The creation of an inpatient advocacy curriculum could complement advocacy education in the outpatient setting to better meet the needs of trainees.