Hurdles to Legislative Advocacy Training in the United States

To the Editor: We read the plea of Bhate and Loh1 for mandatory advocacy training in Canada with great interest. We echo the call for medical student/resident education in health advocacy and describe our own initiatives in a U.S. state-sponsored institution. The Accreditation Council for Graduate Medical Education requires legislative advocacy education. For example, program requirements for anesthesiology residency2(p19) indicate the program’s responsibility to educate residents about “legislative and regulatory issues.” We accept this charge and update residents and medical students by conference or lunch meetings of legislative and regulatory issues germane to their future careers. However, as physicians at a state institution, we are subject to a number of draconian regulations that create barriers to effective legislative advocacy education. First, administrative staff may be uncomfortable sending electronic reminders or nonpolitical announcements about educational events in fear of state policy which prohibits use of state “resources” for legislative advocacy. In accordance with policy, these electronic announcements must be apolitical, must not be interpreted as favoring a candidate/legislator unless physicians need to contact them about an impending issue, and must not be coercive. Second, the state medical association and their council on medical education are reluctant to support resolutions to encourage or mandate legislative advocacy educational efforts, preferring not to get involved in specific school curricula. This self-imposed paralysis at the administrative level prevents effective, appropriate legislative medical education and disadvantages physicians while nonphysicians are afforded such opportunities in their training.3 State and national specialty societies have an opportunity to offer innovative solutions to these challenges. The Texas Society of Anesthesiologists encourages and facilitates resident participation in governmental committees, sponsors CPR training events for legislative staff, and interactive legislative educational events for residents. They have instituted a competition between state anesthesia departments to encourage resident participation in the nonpartisan American Society of Anesthesiologists Political Action Committee. Participation is educational in nature as a nominal $25 contribution is not primarily economic. Even in these instances, residents are potentially limited by state regulations and are frequently forced to communicate “off-line” and on nonuniversity sites. We thank Bhate and Loh for the call to action. As they note, Canadian students are already seeking independent opportunities to achieve some of these educational goals, and we risk a similar fate if we cannot provide U.S. students with the legislative advocacy education they need. Evan G. Pivalizza, MD Professor of anesthesiology, University of Texas Medical School–Houston, Houston, Texas; [email protected] Omonele O. Nwokolo, MD Assistant professor of anesthesiology, University of Texas Medical School–Houston, Houston, Texas. George W. Williams, MD Assistant professor of anesthesiology, University of Texas Medical School–Houston, Houston, Texas.

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