Learning about Inclusion Health in undergraduate medical education: a scoping review.

OBJECTIVES

An Inclusion Health movement has gained momentum over the past decade, aiming to address the extreme health inequities faced by socially excluded groups (including people experiencing homelessness, problem substance use, Gypsy, Roma and Traveller communities, vulnerable migrants, sex workers, people in contact with the justice system and victims of modern slavery). Despite this progress, there is a lack of understanding of how the issues are being taught by medical schools. We conducted a scoping review to identify and analyse existing research about Inclusion Health content and pedagogy in undergraduate medical education.

DESIGN

A stepwise scoping review methodology was followed in accordance with the latest manual for evidence synthesis from Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.

DATA SOURCES

A search was undertaken across six bibliographic databases, and additional articles were found through citation and grey literature searching.

ELIGIBILITY CRITERIA

Primary research studies and evidence reviews from 2013 onwards were included. There were no restrictions on language.

DATA EXTRACTION AND SYNTHESIS

Standardised methods were used to screen possible papers. A charting table was developed to record key information from the 74 papers included. Quantitative steps of the analysis included frequency counts of the extent, nature and distribution of the studies; this was followed by basic qualitative content analysis.

RESULTS

Most educational interventions were optional, or student led, with no longitudinal integration across curricula. There was little evidence of co-production with people with lived experience. Challenges included limited curricula time and faculty expertise, being an emotionally challenging subject, limitations of the biomedical model and informal learning perpetuating stigma. Key enablers included structured reflection, support, positive role models, interaction and co-production with people with lived experience, community partnerships and faculty commitment.

CONCLUSIONS

Developments in undergraduate medical education are required to produce doctors equipped to meet the needs of socially excluded groups. We have summarised key aspects of the literature that will be useful to clinicians and educators in this endeavour.

TRIAL REGISTRATION NUMBER

A review protocol was preregistered in the Open Science Framework on 11 May 2023 and can be accessed at https://osf.io/6c2rk/.