{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:18:14Z","timestamp":1790626694916,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T00:00:00Z","timestamp":1672790400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100014735","name":"Royal College of Physicians and Surgeons of Canada","doi-asserted-by":"publisher","award":["F16\u201001637"],"award-info":[{"award-number":["F16\u201001637"]}],"id":[{"id":"10.13039\/100014735","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012161","name":"Faculty of Medicine, University of British Columbia","doi-asserted-by":"publisher","award":["20R73616"],"award-info":[{"award-number":["20R73616"]}],"id":[{"id":"10.13039\/100012161","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["asmepublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Education"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Learners and physicians are expected to practice as health advocates in Canadian contexts, but they rarely feel competent to practice this critical role when they complete their training. This is in part because advocacy is seen as \u201cgoing above and beyond\u201d routine practice and pushing the boundaries of systems that are resistant to change. Medical learning contexts are rife with barriers to learning about and practicing advocacy, and there is now a need to understand how contexts impact advocacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using constructivist grounded theory study, we generated data through individual and group interviews with medical learners to explore the barriers and facilitators to advocacy in a variety of learning\/practice contexts. We used purposeful and theoretical sampling to ensure that diverse learning contexts and learners who had different views on advocacy were represented. We constructed a theoretical model to understand advocacy decision\u2010making through cycles of initial, focused and theoretical coding, using constant comparative analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Learners' thinking about health advocacy was framed by their own unique knowledge and beliefs, as well as their institutional and organisational contexts. With these influences in mind, learners made decisions about when to advocate within a local decision\u2010making context, guided by affordances and barriers to advocacy involved in their perceptions of the patient, their own social position, resources available and social norms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This framework highlights critical aspects of context that influence learners' ability to learn about and practice as health advocates. If we are to adequately prepare learners for this important work, we must address aspects of their learning and practice contexts that make this work daunting, and we offer learners the tools required to intervene in contexts that do not support their efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/medu.15001","type":"journal-article","created":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T12:54:40Z","timestamp":1670590480000},"page":"658-667","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Health advocacy among medical learners: Unpacking contextual barriers and affordances"],"prefix":"10.1111","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4473-5039","authenticated-orcid":false,"given":"Renate","family":"Kahlke","sequence":"first","affiliation":[{"name":"Division of Education and Innovation, Department of Medicine and Medical Education Research, Innovation and Theory Program McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Family Practice and Centre for Health Education Scholarship, Faculty of Medicine University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"van der Goes","sequence":"additional","affiliation":[{"name":"Department of Family Practice, Faculty of Medicine University of British Columbia  Nanaimo British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7928-555X","authenticated-orcid":false,"given":"Maria M.","family":"Hubinette","sequence":"additional","affiliation":[{"name":"Department of Family Practice and Centre for Health Education Scholarship, Faculty of Medicine University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,1,4]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(10)61854\u20105"},{"key":"e_1_2_12_3_1","unstructured":"FrankJR SnellLS SherbinoJ.CanMEDS 2015 Physician Competency Framework.2015.http:\/\/canmeds.royalcollege.ca\/en\/framework"},{"key":"e_1_2_12_4_1","volume-title":"CanMEDS\u2010FM: A Competency Framework for Family Physicians Across the Continuum","author":"Shaw E","year":"2017"},{"key":"e_1_2_12_5_1","unstructured":"Accreditation Council for Graduate Medical Education.ACGME Common Program Requirements;2020.https:\/\/www.acgme.org\/what-we-do\/accreditation\/common-program-requirements\/"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0b013e3182621c25"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/medu.14526"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/medu.14408"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/medu.13671"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/medu.13929"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/0969733014534879"},{"key":"e_1_2_12_12_1","volume-title":"Constructing Grounded Theory","author":"Charmaz K","year":"2014"},{"key":"e_1_2_12_13_1","volume-title":"Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis","author":"Charmaz K","year":"2006"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.4135\/9781848608191"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102929.2006.02418.x"},{"key":"e_1_2_12_16_1","volume-title":"The Coding Manual for Qualitative Researchers","author":"Salda\u00f1a J","year":"2013"},{"key":"e_1_2_12_17_1","unstructured":"ScottI HubinetteMM Van der GoesT KahlkeR.\u201cThrough a tainted lens\u201d: trainees perceptions of patients' \u201cdeservingness\u201d of health advocacy."},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000001316"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/medu.14200"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/medu.12523"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/1077800410383121"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/160940691301200122"}],"container-title":["Medical 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