title: Shifts in the interpretation of health advocacy: a textual analysis.
abstract: BACKGROUND
  Health advocacy is widely accepted as a key element of competency-based education. We examined shifts in the language and description of the role of the health advocate and what these reveal about its interpretation and enactment within the context of medical education.
  
  
  METHODS
  We conducted a textual analysis of three key documents that provide sequential depictions of the role of the health advocate in medical education frameworks: Educating Future Physicians for Ontario (1993), CanMEDS 2000 and CanMEDS 2005. We used a series of questions to examine shifts in the emphasis, focus and application of the role between documents. Theoretically, we drew upon Carlisle's conceptual framework to identify different approaches to advocacy.
  
  
  RESULTS
  We identified three major shifts in the language associated with the role of health advocate across our textual documents. Firstly, activities and behaviours that were initially positioned as being the responsibility of the profession as a whole came to be described instead as competencies required of every physician. Secondly, the initial focus on health advocacy as representing collective action towards public policy and systems-level change was altered to a primary focus on individual patients and doctors. Thirdly, we observed a progression away from descriptions of concrete actions and behaviours.
  
  
  CONCLUSIONS
  This study uncovers shifts in the language of physician advocacy that affect the discourse of health advocacy and expectations placed on physicians and trainees. Being explicit about expectations of the medical profession and individual practitioners may require renewed examination of societal needs. Although this study uses the CanMEDS role of Health Advocate as a specific example, it has implications for the conceptualisation of health advocacy in medicine and medical education globally.
authors.affiliation: Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Maria
authors.initials: M
authors.lastname: Hubinette
authors.forename: Sarah
authors.initials: S
authors.lastname: Dobson
authors.forename: Angela
authors.initials: A
authors.lastname: Towle
authors.forename: Cynthia
authors.initials: C
authors.lastname: Whitehead
mesh_terms: D001291:Attitude of Health Personnel; D003162:Competency-Based Education / Q000379:methods*; D004501:Education, Medical / Q000379:methods; D006301:Health Services Needs and Demand; D006801:Humans; D009864:Ontario; D010819:Physician's Role; D058996:Quality Improvement; D012941:Social Responsibility