Can medical students facilitate access to healthcare for a seldom heard group through service-learning?

Problem

Medical students are altruistic, highly intelligent, deeply committed and well-motivated members of society. In clinical placements they often struggle to feel useful, consider themselves burdensome on the team and are reliant on supervisors to sign-off decisions. This impedes their autonomy and has potential for dissatisfaction.

Our aim was to engage in a project to help asylum seekers understand their rights, navigate the NHS and improve health literacy through undertaking service-learning. This pedagogy, rare in UK medical schools, is recognised widely in North America. The work held importance for students, voluntary sector partners and people seeking asylum.

Approach

We undertook action research by trying out an educational intervention, critical reflection by multiple stakeholders on its success, modification of the intervention and repetition of the process regularly. The data analysed through note-taking and discussion included numbers of people accessing help, types of problems, feedback from refugees, asylum seekers and voluntary sector hosts, and the transformational impact on the students' learning and personal growth.

Findings

Initially passive didactic interventions were planned with delivery of presentations on how to access care; however, the students quickly realised that more active intervention is better for engagement. Participants were asking for specific advice around their own situations and the session was modified to provide more tailored service. The students were not indemnified for clinical care; however, felt very useful in facilitating GP registration, organising appointments through Choose and Book; filling out HC1 forms and explaining rights to interpretation. An anonymised log of problems was reviewed and the students identified a need for dental care and legal representation. Consequently, they are working up a multidisciplinary approach with dental and law students to widen signposting activities.

The voluntary sector hosts were impressed and requested the students to teach their staff about healthcare charging regulations and managing mental health emergencies. Their recommendations led to invitations from a wider range of hosts to participate in their services.

Students learning has been around the social determinants of health, inequalities and advanced communication skills. They have embedded themselves within community services where students would usually have limited contact and are producing a handbook for future students to use in the project.

Consequences

Owning their own project and gaining confidence in managing its development has led to students feeling they have an important role in our local community. The project is thriving and the students are succession planning. In renaming the project Students for Universal Health Access (SUHA) they have demonstrated their understanding of the value of advocacy in care. They plan educational sessions on rights to care for medical students not involved in the project and their passion is palpable. We report the service-learning model has been successful and we recommend this approach.