Clinical humanities - a precursor to social prescribing?

Problem

Social prescribing and clinical humanities are encouraged by RCGP, with Public Health England and the NHS actively promoting and implementing social prescribing. How is this to be reflected in medical undergraduate curricula?

This study examined the relationship between clinical humanities and social prescribing, to assess the impact of clinical humanities in medical undergraduate GP teaching and whether this could be an antecedent to developing social prescribing skills. It draws on the lessons learnt from an undergraduate curriculum implementation of social prescribing and clinical humanities projects.

Approach

As part of the undergraduate medical curriculum, second-year students (n=400) undertook a student-led group project during their longitudinal general practice placement. Half of the groups explored social prescribing for physical activity, the Active Practice project, and half carried out a clinical humanities project producing a creative response to their placement.

Qualitative data were coded using NVivo 12 software and findings triangulated.

The data analysed included:

• Two focus groups with students from Active Practice cohort (n=7, n=8)

• Free text comments from GP tutor evaluation questionnaires (n=15) and student evaluation

• questionnaires (n=315), both cohorts.

• A sample of student reflective essays submitted for assessment: Active Practice (n=18), Clinical Humanities (n=19)

Findings

Students from the clinical humanities cohort demonstrated learning which linked with the Active Practice project, sometimes triangulating with areas identified for improvement. Humanities students understood and empathised with vulnerable patients’ health in the context of their lives. This linked with Active Practice findings to tailor the approach to suit patients’ own goals, increase participation and satisfaction. Humanities students grasped the local nature of general practice, reporting a better understanding of the demographic issues. Some Active Practice students commented that they needed better insight into the Practice and its community to create a project with more sustainable impact. Humanities students engaged on a personal and emotional level with patients in a way which was able to motivate the team to move forward with ambitious projects. Both Active Practice and Clinical Humanities projects built students’ knowledge of the structure of primary care, including clinical commissioning and interactions with local services related to their projects.

Consequences

There is scope for medical students to have experiential learning opportunities in General Practice concerning clinical humanities, which can be beneficial for student learning and empathising, enabling GPs to develop their social prescribing skills and potentially improving patients’ lives. In the current cohort, COVID-19 has produced additional challenges for the projects such as reduced placement which may impact on the experiential learning gained.

The pandemic has further highlighted the significance of social determinants of health including physical activity on morbidity. Consequently, clinical humanities and Active Practice projects are important to enable medical students to influence these social determinants in their future careers.