An evaluation of cascading mentorship as advocacy training in undergraduate medical education.

BACKGROUND: Physicians are in a position of great influence to advocate for health equity. As such, it is important for physicians-in-training to develop the knowledge and skills necessary to fulfil this role. Although various undergraduate medical programs have implemented health advocacy training, they often lack experiential learning and physician involvement. These aspects are foundational to the Advocacy Mentorship Initiative (AMI) which utilizes cascading mentorship as a novel approach to advocacy training. Medical students develop advocacy competency as peer mentors to youth raised in at-risk environments, while also being mentored themselves by physician residents. We aim to determine whether there are specific advantages to utilizing cascading mentorship to facilitate the attainment of advocacy competencies in undergraduate medical education. METHODS: Medical students participating in AMI between 2017 to 2020 completed pre- and post-exposure questionnaires. Questionnaires assessed confidence in advocacy-related skills and knowledge of youth advocacy concepts, as well as learning goals, skills gained, benefits of AMI and resident mentors, and impact on future career. Sign tests were utilized to analyze quantitative results, and content analysis was used for open-ended responses. A triangulation protocol was also utilized. RESULTS: Fifty mentors participated, 24 (48%) of which completed both pre- and post-exposure questionnaires. Participants gained confidence in advocacy-related skills (p < 0.05) such as working with vulnerable populations and advocating for medical and non-medical needs. They also reported significant improvements (p < 0.01) in their understanding of social determinants of health and concepts related to children's health and development. Content analysis showed that participants built meaningful relationships with mentees in which they learned about social determinants of health, youth advocacy, and developed various advocacy-related skills. Participants greatly valued mentorship by residents, identifying benefits such as support and advice regarding relations with at-risk youth, and career mentorship. AMI impacted participants' career trajectories in terms of interest in working with youth, psychiatry, and advocacy. CONCLUSIONS: AMI offers a unique method of advocacy training through cascading mentorship that engages medical students both as mentors to at-risk youth and mentees to resident physicians. Through cascading mentorship, medical students advance in their advocacy-related skills and understanding of social determinants of health.

Mistrust of the medical profession and higher disgust sensitivity predict parental vaccine hesitancy.

Despite overwhelming evidence that vaccines are safe and effective, there has been a rise in vaccine hesitancy and refusal leading to increases in the incidence of communicable diseases. Importantly, providing scientific information about the benefits of vaccines has not been effective in counteracting anti-vaccination beliefs. Considering this, better identification of those likely to be vaccine hesitant and the underlying attitudes that predict these beliefs are needed to develop more effective strategies to combat anti-vaccination movements. Focusing on parents as the key decision makers in their children's vaccination, the aim of this study is to better understand the demographic and attitudinal predictors of parental vaccine hesitancy. We recruited 484 parents using Amazon MTurk and queried their attitudes on childhood vaccination, level of education, age, religiosity, political affiliation, trust in medicine, and disgust sensitivity. We found three main demographic predictors for parental vaccine hesitancy: younger age, lower levels of education, and greater religiosity. We also found vaccine hesitant parents to have significantly less trust in physicians and greater disgust sensitivity. These results provide a clearer picture of vaccine hesitant parents and suggest future directions for more targeted research and public health messaging.