"Building a More Inclusive Blood System in Canada": A Mixed-Methods Evaluation of a Workshop to Guide Medical Students to Develop as Health Advocates Through Advancing Health Equity in Blood Product Donation for Gay, Bisexual, and Queer Men
Authors: Rosenfeld Aaron , Baribeau Owen , Berscheid Kasey , Chan Sze Wah Samuel , Farrokhi Kaveh , Herman David , Lee Anna , Segall Romy , Singh Navjit , Wroot Hayley , Fingrut Warren 
Published: November 2021

Abstract
Introduction:
Competent and socially responsible physicians require a range of abilities other than medical expertise to effectively meet the healthcare needs of the people they serve, including health advocacy skills. The CanMEDS framework for physician competency outlines that, as Health Advocates, physicians work to determine and understand patient and community needs, speak on behalf of others when required, and support the mobilization of resources to effect change. Although recognized as essential for medical trainees to develop, health advocacy is challenging to teach and assess. Here, we describe the development and evaluation of a workshop to support Canadian medical students to develop as health advocates through advancing health equity in blood product donation for gay, bisexual, and other men who have sex with men (gbMSM) in Canada.
Methods:
We developed a workshop for a Canadian medical student audience, "Building a more inclusive blood system in Canada", consisting of an online module followed by a virtual facilitated discussion group. The online module (available at stemcellclub.ca/training) outlined blood and stem cell donation in Canada for gbMSM, starting from the historical policies and the context in which they were first put in place, to today's policies and where future policies may lie (Fig. A). The module also presented content from a national campaign in Canada to engage gbMSM as stem cell donors (stemcellclub.ca/savingliveswithpride). The discussion group supported participants to reflect on donation policies for gbMSM and their consequences, and discuss how medical students can concurrently advocate for gbMSM and patients in need of blood products. A facilitator guide was developed and facilitator training was provided. A pre- and post- test was administered to participants to assess knowledge transfer. Quantitative and qualitative analyses were employed to evaluate participants' perspectives on the impact of the workshop on their development as health advocates.
Results:
From 10/2020-7/2021, workshops were hosted at 8 medical schools across Canada. 104 medical students from across Canada participated, of whom 65 (63% response rate) completed a pre- and post- workshop survey. 26 (40%) of survey respondents were male, 22 (34%) identified as LGBTQ+ (10 gay, 9 bisexual, 3 other), and 52% were non-Caucasian (from 9 different ancestral groups). 44 (68%) were in the first and 16 (25%) in second years of medical school. Post-workshop, mean scores on a 6-question stem cell donation knowledge test improved from 33% to 79% (p&lt;0.001, Fig B), and 88% felt the workshop prepared them to discuss blood and stem cell donation for gbMSM with others.
98% strongly agreed/agreed the workshop supported their development as health advocates (Fig C), including the abilities to: advocate for patients beyond the clinical environment (83%); work with patients (88%) or communities and populations (74%) to address and identify determinants of health that affect them and their access to care; respond to the needs of communities or populations by advocating with them for system-level change (83%); improve clinical practice by applying a process of continuous quality improvement to disease prevention and health promotion activities (79%); and contribute to a process to improve the health of a community or population they will serve (90%). 94% felt that the workshop should be incorporated into medical curricula.
39 medical students participated in focus groups to share their perspectives on the workshop. (42% male, 37% LGBTQ+ identified, 76% non-Caucasian; 53% in first year of medical school). Qualitative analysis identified rich examples of participant development as health advocates through their participation in the workshop (Fig D).
Conclusion:
We present the perspective of a national cohort of medical students in Canada that their participation in a workshop on advancing health equity in blood product donation for gbMSM contributed to their development as health advocates. This workshop is a model for teaching health advocacy to medical students and is relevant to medical educators and curriculum developers.
Figure 1 Figure 1.

Disclosures
No relevant conflicts of interest to declare.