Table 3.

Themes and Representative Comments from Student Reflections

Overarching Themes & Codes	Code Definitions	Representative comments
Student Education: Comments related to skills obtained during the curriculum
Advocacy skills	Skills, tools, and resources introduced in their workshops	• “I learned that even small acts of advocacy, like collecting outside records or calling providers in the patient’s medical team, can improve a patient’s experience at the hospital and ultimately lead to better care.”
Supervisor role modeling	Modeling from supervisors (attendings or residents)	• “The attending was very good about medication reconciliation at discharge so I learned that making sure patients understand the medication changes and writing the medication changes in the discharge instructions can help a lot with clarity.”
Discharge process	Any component of best practices for the discharge process	• “Additionally, [the patient] and I would go on walks to clear his mind and get him physically active. Given his ongoing anxiety and his multiple symptoms, I consulted with the symptom management team so that he was as comfortable as possible. Prior to discharge, I organized all of his medications onto a sheet with explanations of each medication as well as the dates of his follow up appointments.”
Communication with other providers	Communicating with other providers, like consultants, outside-hospital providers, or patient’s primary care providers	• “In my future clinical practice, I will definitely make a follow-up phone call to discharged patients to see how they are doing and answer any question. Also, it is very important to see what the patients’ needs are and refer them to appropriate teams for the best outcome.”
Student Experience: Comments related to a student’s personal experience and feelings while completing the advocacy assignment
Experience with empowerment	Feeling empowered to advocate and related actions	• “As I develop in my career, I hope to advocate on a policy level. The San Francisco housing crisis is detrimental to the health of our residents, and physicians need to be at the forefront of advocating for policies and funding for safe, affordable housing.”
Communication with patients	Direct patient communication	• “Based on this exercise, I’ve learned that it’s important to always speak directly to the patient and their family about the next steps/plan; you can’t expect things to fall magically into place, because sometimes, a clinic may not necessarily call to remind for the appointment.”
Experience with compassion	Experiencing compassion, which can include: with other providers, with patient, or with providing it	• “The most important skill I’ve learned through this curriculum and through this rotation generally is the tremendous gift we can give of time, attention, and listening. There was little I could do to fix the underlying problems, but I could create space by listening attentively.”
Student gratitude	Student gratitude related to any part of the patient’s care	• “I learned that we can significantly improve our patients experience and outcomes in the hospital by advocating for them. I too learned the joy it brought me knowing that I could be a source of help to my patients in times of difficulty. I believe as healthcare providers, we need to understand our patient’s backgrounds and what barriers to care they face so that we can give them the most comprehensive and competent care. Learning more about my patients, who they are and what is important to them, is something I do plan on incorporating into my clinical practice.”
Stigmas or Labeling	Stigmas or labels around their patients	• “I will also strive to understand the subtleties of various cultural differences of my patients in order to prevent the inappropriate grouping of people into a single cultural box, when they are in fact members of distinct groups.”
Caregiver dynamics	Experiences with patient’s caregivers, including support and challenges	• “Being a hospitalist allows access to a cross-sectional slice of a patient’s life, confined to one moment in time but comprehensive in that we get to see and coordinate all aspects of the patient’s health. From taking care of A. in the hospital I knew her family has been caring for her all her life; now that she is 19 they are struggling to determine a sustainable plan that balancing her needs with allowing her some independence.”
Barriers to Care: Comments related to SDH that play a part in patient care
	SDH that play a part in patient care	• “[The patient] taught me a lot about the conditions in SROs (single room occupancies). It is easy to assume that any housing is better than no housing, but I learned that people can feel even more unsafe in a building than they do outside. [The patient] experienced sexual violence in her SRO and genuinely fears the drug-related activity that occurs in her hallways.”
Interdisciplinary Dynamics: Comments related to the role of interprofessional team members in patient advocacy
	Role of interprofessional team members in patient advocacy	• “I learned to communicate with team members such as social workers, in finding the best possible resources for our patients. While these services are not available at every hospital, I know have knowledge about community resources available for my future patients and can contact them on my own.”