Preparing Students to Care for Socially Excluded Patients: A Qualitative Study of Inclusion Health in Undergraduate Medical Education.

INTRODUCTION: Extreme health inequities are experienced by Inclusion Health 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). There is evidence that undergraduate medical education is failing to prepare students to work effectively with these socially excluded groups. This research explores challenges and opportunities in teaching Inclusion Health to medical students.

METHODS: Twenty-three educators involved in teaching Inclusion Health at medical schools in the United Kingdom and Ireland were recruited purposively through known contacts and snowball sampling. Semistructured interviews were conducted, and the interview transcripts were analysed using reflexive thematic analysis. An inductive approach was taken, and the analysis was underpinned by a critical realist ontology.

RESULTS: Five distinct themes were identified from the data: 'My goodness me, it's difficult to get that stuff in'; creating space for Inclusion Health in undergraduate curricula 'It's the human-to-human connection'; the importance of meaningful contact with people with lived experience The impact of the hidden curriculum 'Assessment is the biggest hurdle' Inclusion Health as a core competency for clinical practice CONCLUSION: Inclusion Health groups, who face intersecting forms of exclusion such as poverty, violence and trauma are at risk of being further excluded by undergraduate medical curricula. This paper enhances understanding of the challenges that are limiting Inclusion Health education. Most importantly, the paper presents solutions for how Inclusion Health can be incorporated into undergraduate medical teaching and assessment.