Quick facts

• Year: 2021

• Country: United States of America

• Institution: Keck School of Medicine of the University of Southern California (USC)

• Learners: Medical students

• Aims:  To help medical students understand unfair health differences, reflect on their role as future doctors, and develop skills to support fair, respectful care and health justice in clinical practice.

Why was the education intervention developed?

The intervention was developed because medical educators increasingly recognised that many differences in health outcomes are shaped by long-standing social, economic and system-level factors, rather than individual behaviour alone.

They recognised their existing medical training focused on diagnosis and treatment but gave less attention to how healthcare systems and social conditions can create unfair barriers for certain groups.

Therefore, the education intervention was created to fill that gap by helping medical students understand why these inequalities exist and how they affect patients in real life. It also encouraged students to reflect on their role as future doctors, not only as clinicians but as professionals who work within larger systems.

By embedding this learning across multiple stages of medical training, the intervention aimed to prepare students to provide fair, respectful care and to recognise opportunities to improve the systems in which they will practice in the future.

What did the education intervention do?

The intervention was mandatory and ran alongside other aspects of the course from the early stages through to clinical placements.

Prior to placement / clerkship, students had 22 teaching sessions over three semesters that included a range of speakers and topics about racism in medicine, social sciences and health inequity.

This phase also included guided small-group activities that encouraged students to reflect on what they were learning.  Alongside classroom learning, students participated in 12 hours of community-based experiences working with local organisations to better understand health challenges outside the hospital setting, and learn directly from communities affected by inequality and develop relationship building skills based on cultural humility. 

Students attended 2-week clerkships / placements in various settings.  Learners were encouraged to connect their experiences on the wards with the theory they learned earlier in the course in several seminars.

Throughout the intervention, students completed reflections, case discussions, and group projects that asked them to think critically about patient care, communication and their responsibilities as future doctors.

Overall, the intervention guided students step by step to develop a deeper understanding of fairness in healthcare and how they can contribute to more respectful, thoughtful and just care in their future practice.

How was the education intervention evaluated?

Students regularly shared feedback after sessions and at the end of each semester, rating how useful they found the course and explaining what they enjoyed or found challenging.

This feedback helped the teaching team understand which parts of the course were working well and which needed improvement. 

Students’ learning was also reviewed through written assignments, reflections, group work and quizzes.
Facilitators used marking guides to keep assessment fair and consistent.

Over time, this information was used to adjust the course structure, improve activities and better support students at different stages of learning.

What was the impact of the education intervention?

The intervention had a positive impact on how students viewed health inequalities and their role as future doctors.

Many students said the course helped them better understand the experiences of patients from different backgrounds and encouraged them to think more carefully about fairness in healthcare.

Feedback showed that students valued hearing from guest speakers and community organisations, and many felt the course helped them reflect on their attitudes, communication and responsibilities in clinical settings.

While some students wanted more practical examples and clearer links to clinical work, the overall response was positive.

The course also helped embed conversations about fairness, respect and social responsibility into medical training, supporting a more thoughtful and socially aware approach to patient care.

Key learnings

• Students valued having protected time within the curriculum to explore fairness in healthcare, reflect on patient experiences and consider their responsibilities as future doctors beyond diagnosis and treatment.

• Guest speakers, community involvement, and reflective activities helped students better understand real-world health differences and encouraged more thoughtful, respectful approaches to patient care.

Challenges

• Students entered the course with different levels of prior knowledge, making it difficult to design activities that felt equally relevant and engaging for everyone.

• Some students found small-group activities less effective and wanted clearer, more practical examples of how doctors can address unfair health differences in clinical settings.

Recommendations

• Continue developing the course as a long-term, required part of medical education, with stronger links to clinical teaching so learning feels relevant to practice.

• Improve small-group learning and include more practical, real-life examples, while supporting faculty to confidently teach and model fair, respectful care.