Advocates in training
Until recently, second-year resident Greg Sawicki, MD, had learned almost everything he knew about medicine either in the classroom or at a patient's bedside. This year, though, he and several other residents got the chance to learn their craft in a new venue: the communities of the people they take care of every day. Along with clinical care, research and education, community service is part of Children's Hospital Boston's four-part mission, and for Sawicki, advocacy has been a memorable experience.
He and his colleagues partnered with the Jamaica Plain Asthma Environmental Initiative—a community group working to eliminate asthma in schools and homes—to better understand barriers to asthma care from the perspective of families of asthmatic children. The residents ran focus groups and listened to the families' needs and perceptions of the shortcomings of current asthma care systems.
"We learned that parents want more care and education in schools and are concerned about leaving their children in a school environment that can't offer much help with asthma management," says Sawicki. Those worries, he says, concern everything from teachers who don't know how to respond to an asthma attack to inconsistent policies around asthma management and medications. As a follow up to the focus groups, the residents will be heading to classrooms in local schools to educate kids about asthma.
Sawicki's asthma project is part of Children's Advocacy Clinic Training (ACT) project, a program that helps residents gain advocacy experience and make a positive impact in the community. ACT is offered to residents as part of their weekly primary care training, and integrates advocacy with traditional pediatric medical education. Under the direction of resident leaders, and with the guidance of staff from the Office of Child Advocacy (OCA), residents are given time during rotations to participate in advocacy efforts. This includes testifying at legislative hearings, volunteering at community-based organizations, working in local schools and meeting with policy makers.
As the keeper of the community service portion of the hospital's mission, OCA staff have found that getting medical residents involved in advocacy has a dual benefit. "The residents are enriched by learning to advocate," says M. Laurie Cammisa, Esq., vice president of Child Advocacy, "and our department's advocacy efforts are strengthened when a young doctor takes the time to work with a community organization, or communicate with a legislator about his or her experiences caring for children."
This effort has been so successful that Children's has become a national leader in incorporating advocacy into pediatric residency training. In fact, the hospital hosts the National Program Office for the Anne E. Dyson Community Pediatrics Training Initiative, which provides funding and technical assistance to pediatric training sites across the country.
The OCA shares this commitment to promoting learning environments that ultimately will change the course of traditional pediatric training. "The partnership between OCA and the Initiative originated because we shared a determination to have physicians view their patients in terms of their larger community context," says Joseph Carrillo, MD, vice president of Diversity and Access. "We want them to learn, for instance, to treat the symptoms of asthma while addressing how broad factors such as poor housing conditions or environmental pollution affect that child's condition."
For Greg Sawicki, looking at the problem in this broad context made a world of difference. "In our asthma program we learned that we can get as much done through advocacy in the community as in the clinic setting."
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