Training a New Generation of Advocates

Pediatric residents benefit from obesity prevention advocacy training
By Cindy Hutter

The shift to address health topics, like childhood obesity, from multiple angles—clinical care plus coordinating with community groups to address the social determinants of health—means doctors entering the field today need additional and new kinds of training to prepare them for the changing healthcare landscape.

Be Our Voice Online CourseDuke University School of Medicine’s Pediatric Residency Program is leading the way when it comes to preparing its residents for entering this new era of healthcare. With the help of NICHQ and its obesity prevention advocacy training, Duke pediatric residents are discovering how to advocate for programs and policies that support healthy, active living for children beyond the office visit and in the community.

Through a project called Be Our Voice External Link, NICHQ developed the three-part, web-based obesity prevention advocacy training. In the first component, an interactive e-book provides information and best practices for becoming an advocate and using effective advocacy methods. Second, users have a chance to practice their advocacy skills in a simulated virtual community by completing six different scenarios. Lastly, participants create a personal advocacy plan to help move their advocacy work forward.

Duke chose the online obesity prevention advocacy training as a way to help supplement its more didactic clinical activities. “This is something that can really hold residents’ attention, and they don’t feel like they are being asked to do something without a reason behind it. They are creating an advocacy plan they can put into action,” explains Debra Best, MD, assistant professor of pediatrics at Duke and the advocacy rotation director.

During Duke’s month-long advocacy rotation, residents spend time in the Duke Children’s Healthy Lifestyles Clinic, work with community groups to do home visits, go into school systems to give classes on healthy living, as well as work with local dentists and pediatricians and spend time with the legislature when in session. Residents also participate in a quality improvement project at Bull City Fit, a community-based wellness program associated with Duke.

“A lot of residents have taken their advocacy plans and done amazing things within the Bull City Fit community,” says Sarah Armstrong, MD, associate professor of pediatrics at Duke and director of the Duke Healthy Lifestyles Program.

For example, one resident talked with patients and families in the clinic about their barriers to physical activity and learned a lot of children wanted to swim, but were self-conscious about wearing a bathing suit. After working with Bull City Fit and the local recreation department, the resident advocated for changing the policy that prohibited swimmers from wearing T-shirts in the pool. Once the policy changed, more families started going to the pool.

In another project, the resident team of Amber Hathcock and Laura Page received funding to develop a physical education curriculum for an underserved community within Bull City Fit. In a project called “Ready, Set, Play,” Hathcock and Page created a program targeting the younger siblings (3 to 6 years old) of children with an elevated BMI (since studies External Link show that an elder child in a family with an elevated BMI puts the younger siblings at risk).

“We knew there would be a handful of kids at the community center sitting on the sidelines because they were not old enough for other activities at the center,” explains Page about why they started a program targeting 3-6 year olds.

The duo opened the program in February four nights a week and one afternoon on weekends. Attendance fluctuates from three to seven kids at a time. It’s been the start Hathcock and Page expected and one they hope to build upon.

“[The advocacy training] definitely prepared us to realize what is feasible to do, as well as what is most helpful, for families. It helps you think of different perspectives of advocacy projects,” says Hathcock. “You want to go out and save the world, but how do you do it? The program was a nice way to break it down into actual, feasible chunks that you can actually carry out.”

In a survey at the end of their advocacy rotation, the majority of Duke residents reported feeling more confident in their ability to complete a community advocacy project.

“This project has been a really great experience, and I absolutely plan to stay involved with advocacy work,” says Page.

Learn more and register for NICHQ’s obesity prevention advocacy training through the NICHQ learning center External Link. For group pricing, contact us at