Bridging the Gap: Exploring Barriers and Opportunities for Students to Facilitate Advocacy Integration in Canadian Medical Education

Background: Health advocacy remains inconsistently integrated in Canadian medical education despite being a core CanMEDS competency. This review examined barriers to medical student advocacy participation and identified practical opportunities for self-directed engagement. Methods: We conducted a systematic literature search of MEDLINE and grey literature (from 2010 to 2025) focusing on medical student advocacy participation, educational frameworks, and barriers. Two independent reviewers screened 1,253 citations using predefined criteria. Forty studies were narratively synthesized. Eligibility criteria: Population: Medical students Intervention or exposure: Participation in advocacy efforts (e.g., health policy, health equity, political engagement). Educational frameworks, curricula, or structured programs supporting advocacy in medical education. Comparator: Not required. Primary outcome: Barriers to medical student advocacy (e.g., time constraints, institutional resistance, lack of training). Opportunities for enhancing advocacy skills within medical education (e.g., mentorship, policy involvement). Effectiveness of structured frameworks in integrating advocacy into medical training. Study designs: Any study design that produced primary data. Other criteria: Published in English or French language. Results: Three primary barriers emerged: inconsistent advocacy training across institutions, lack of recognition of physician influence on health policy, and insufficient health policy skills development. Four evidence-based opportunities for student engagement were identified: seeking mentorship from faculty advocates and external advocates, participating in legislative lobby days, developing communication skills through writing and public speaking and collaborating with medical societies and nonprofit organizations. Conclusions: Medical students can proactively develop advocacy competencies through structured self-directed activities. Future work should focus on implementing standardized advocacy curricula across Canadian medical schools with ongoing evaluation of effectiveness.