Ashwell Gemma, Russell Amy M, Williamson Andrea E, Pope Lindsey M
Faculty of Medicine and Health, University of Leeds, Leeds, UK
Faculty of Medicine and Health, University of Leeds, Leeds, UK.
BMJ Open. 2025 Apr 30;15(4):e092420. doi: 10.1136/bmjopen-2024-092420.
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.
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.
A search was undertaken across six bibliographic databases, and additional articles were found through citation and grey literature searching.
Primary research studies and evidence reviews from 2013 onwards were included. There were no restrictions on language.
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.
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.
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.
A review protocol was preregistered in the Open Science Framework on 11 May 2023 and can be accessed at https://osf.io/6c2rk/.
在过去十年中，包容性健康运动蓬勃发展，旨在解决社会排斥群体（包括无家可归者、药物使用问题者、吉普赛、罗姆和旅行者社区、弱势移民、性工作者、与司法系统有接触的人以及现代奴隶制受害者）所面临的极端健康不平等问题。尽管取得了这一进展，但对于医学院校如何教授这些问题仍缺乏了解。我们进行了一项范围综述，以识别和分析本科医学教育中关于包容性健康内容和教学法的现有研究。
按照乔安娜·布里格斯研究所最新的证据综合手册以及系统评价和Meta分析扩展的范围综述首选报告项目指南，采用逐步范围综述方法。
在六个文献数据库中进行了检索，并通过引文和灰色文献检索发现了其他文章。
纳入2013年起的原发性研究和证据综述。对语言没有限制。
使用标准化方法筛选可能的论文。开发了一个图表来记录纳入的74篇论文的关键信息。分析的定量步骤包括对研究的范围、性质和分布进行频率计数；随后进行基本的定性内容分析。
大多数教育干预是可选的，或者是由学生主导的，没有在整个课程中进行纵向整合。几乎没有证据表明与有实际生活经验的人共同开展项目。挑战包括课程时间有限和教师专业知识不足、这是一个情感上具有挑战性的主题、生物医学模式的局限性以及非正式学习使耻辱感长期存在。关键推动因素包括结构化反思、支持、积极的榜样、互动以及与有实际生活经验的人共同开展项目、社区伙伴关系和教师的承诺。
本科医学教育需要发展，以培养有能力满足社会排斥群体需求的医生。我们总结了文献的关键方面，这将有助于临床医生和教育工作者在这一努力中。
2023年5月11日在开放科学框架中预先注册了综述方案，可在https://osf.io/6c2rk/上获取。
