Reforms to medical education and training to address health inequalities and the social determinants of health
| Domain | Action | Examples |
|---|---|---|
| Medical school selection/retention | ||
| Outreach | St George's, University of London's primary practice after-school club: offers children from local primary schools the opportunity to learn about medicine.29 Hull York Medical School's ‘Emergency room’: uses virtual scenarios to engage aspiring pupils in emergency medicine, with priority given to under-represented groups.30 Brighton and Sussex Medical School's ‘BrightMed’: a 5-year rolling programme that works with students from widening participation backgrounds to become tomorrow's doctors.30,31 University of Cambridge School of Clinical Medicine's Cambridge Sutton Trust summer school in medicine: this targets year-12 students from schools with below national average exam performance and provides a residential programme that gives a realistic view of studying medicine.30,32 | |
| Remove selection barriers | Sunderland Medical School uses a ‘roles and responsibilities’ form as part of recruitment as opposed to extra-curricular activities.33 UK Widening Participation in Medicine (UKWPMed) Scheme of six UK medical schools (Birmingham, Brighton and Sussex, Hull York, Keele, Manchester and Peninsula) offer alterations in selection for applicants from under-represented backgrounds (including prioritisation for interview selection or reduction in offer requirement).34 | |
| Support in medical school | There are several extended medical degree programmes offering extra support to students from under-represented groups where required, such as the University of Leicester's Medicine with Foundation Year programme. | |
| New medical degree structures | Medical school gateway programmes show considerably greater proportions of students from state schools, deprived areas and low socio-economic status backgrounds.26,27 | |
| Undergraduate education | ||
| SDH/HI as a core thread in curriculum | Northern Ontario School of Medicine explicitly acknowledges its duties towards social accountability and health inequalities in its mission: ‘To improve the health of Northern Ontarians by being socially accountable in our education and research programs and advocating for health equity.’35 | |
| Experiential learning in deprived communities | ||
| Assessment of SDH/HI in undergraduate programmes | ||
| Medical humanities | Many UK medical schools offer selected modules in medical humanities for medical students. | |
| Postgraduate education | ||
| Advanced consultation skills for behaviour change | Motivational interviewing, cognitive behaviour therapy and collaborative agenda setting techniques are all of relevance to behaviour change and management of long-term conditions. | |
| Understanding of local landscape of third sector support services | RCGP: Social inclusion commissioning toolkit. This practical guide is designed to support CCGs, LAs and HWBs to commission health services in ways that improve health outcomes for the most vulnerable groups.36 | |
| Audit and QI of health inequalities in their practice | NHS England: equality and health inequalities (EHI) RightCare pack: information on local CCG and areas for improvement to guide QI projects.37 | |
| Specialty-specific learning of HI/SDH | Kidney Research UK and the renal medicine community have reviewed specialty-specific health inequalities and developed a comprehensive strategy to address it.38 | |
| HI/SDH in postgraduate exams | ||
| Post-CCT career trajectories and education | ||
| Formalisation of careers for those with population health interest | Role models championed by specialty organisations, eg Dr Pippa Medcalf, the RCP lead fellow in health inequalities and inclusion health.39 | |
| A credential in population health and inequalities | ||
| Creation of regional networks of specialty physicians with responsibility for HI | The RCP-established Inequalities in Health Alliance seeks to bring together stakeholders with an interest in improving the health of the UK.40 |
CCG = clinical commissioning group; CCT = certificate of completion of training; HI = health inequalities; HWB = health and wellbeing board; LA = local authority; RCGP = Royal College of General Practitioners; RCP = Royal College of Physicians; SDH = social determinants of health; QI = quality improvement.