Main results from the meta-synthesis
| Primary quotes from the studies included | Synthesis of the findings from the learners’ perspective | Application of the themes to social justice |
| ‘So I think I developed a sense of compassion for a group of people that I didn’t previously understand as well. Hopefully that makes me a better physician for that.’41 (p. 940) ‘The writing assignment that asked us to remember one moment where we noticed implicit bias in ourselves was really helpful. It made me reflect on something that I hadn’t thought about in a while. I didn’t realize that I could make progress thinking about it the way that I did.’42 (p. S153) | Personal growth: understanding one’s own emotional self and biases for personal growth was important to learners and was linked to their well-being, belonging and reduced stress. | Learners acquire skills that could be used in the clinical settings and with those accessing services and treatment. |
| ‘I learned to communicate with team members such as social workers, in finding the best possible resources for our patients. While these services are not available at every hospital, I know have knowledge about community resources available for my future patients and can contact them on my own.’19 (p. 4) | Professional development: requires medical students, residents and academic faculty to acknowledge softer concepts in medicine and to work to address them. A major facilitator to this effort within medical schools would require structured curricula. | Learners build confidence to elicit resources and look beyond the confines of the hospital or clinical lens. |
| ‘I believe that as physicians we have a responsibility towards the public good and the health of the population and I think that part of this purview is working to undo the injustices that have become established in our society.’21 (p. 6) |
Developing commitment to working with marginalised populations:
intentional awareness of the individual and group challenges was understood in relation to the level of resources and opportunities that did not exist for individuals with far less than originally thought by learners. | Emerging understanding of health disparities and social justice work with the identity formation of the learner was seen as an eye opener and led to compassionate ways of working in local communities. |
| ‘I gained some insight into the fact that, I take a lot of … my own health knowledge for granted … and … someone like the Marshallese population who’s in a foreign culture and in a foreign land and even foreign to our language may need more assistance as a community. As one participant said, ‘You’re not going to understand all the other cultures, but when something happens that’s really off, you can take a step back and say, ‘Am I missing something?,’ ‘Do I need to learn more about this culture before I get frustrated at this patient for being this way?’’43 (pp. 217–8) ‘I used to think: ‘Well, it’s their [Marshallese people] fault for not going to the doctor.’ When you actually learn about a culture … it really puts it into perspective as far as … most of [the Marshallese] health issues are due to all the radiation we dumped on their islands. I feel much more sympathetic, empathetic, and responsible. I’m sure our country told them that it would be fine. I’m sure we misled them. They’re probably still being misled a lot of times.’43 (p. 218) | Local environments: looking at social, economic and political contributions to the conception of health disparities that lead to social justice in biological explanations and health. | Local visits of neighbourhoods and non-profits for learners were linked to a better understanding of local health disparities and the accessible resources. |
| ‘Absolutely. It was a useful experience to dive into more detail on a social and cultural history with the patient and make that the focus of the interview to understand more about how it affects them and their potential treatment.’30 (p. 5) ‘I do believe that this was a very useful way to integrate the medical and cultural aspects of the medical interview. As well, it allowed us to begin to investigate how the social/belief systems can impact health, healing mechanisms and perspectives of wellbeing. I do believe it will help me in the future when I am presented with an Indigenous patient and how to allow the topics of religion and belief systems into the interview.’30 (p. 7) |
Integrating traditional clinical skills:
allowing differences and diversity in knowledge to form as part of the professional identity and feel comfortable with it in the Western practice of medicine. | Using a collective approach to understanding individual differences in health and medicine, incorporating the individual’s perspective into treatment and care. |
| ‘Motivation to serve…. It is not enough to observe the injustice, but we must do what we can to take action to start impacting the people around us.’44 (p. 4) | Importance of advocacy: advocacy was linked to learners’ motivation to help and have a goal to make an impactful change for individuals. | Requires learners to have goals to act on for positive outcomes. |
| Scholar’s experience with the East Harlem Community Health Committee: ‘Over the next few months I worked with the committee to device a project. The committee has, for a long time, needed a better understanding of the landscape of pediatric mental health resources in the East Harlem community. Through many meetings and conversations, we decided to investigate how children and adolescents enter the mental health system in East Harlem and what this experience looks like. In order to answer these questions, we decided that I would do field research – mainly structured interviews – to create a map of the process…. Luckily, the structure of the HRSJ program, with new students entering each year is that these projects can be passed on, creating sustainability and continuity with the community partners. There have now been three additional years of students working on this same project.’45 (p. 295) |
Human rights and social justice:
stereotyping, cultural insensitivity, stigma, health insurance coverage and access to health and housing were important factors that lead to injustice in society and gaps in healthcare outcomes for minority groups. | Interest in human rights: increasing learners’ awareness of factors that contribute to health disparities in minority populations. |
| ‘I felt that the public isn’t aware of the problems other areas of the world is facing, and the impact they’re going to make in a global situation. I want to be the educator to the public and hopefully, be able to make a small difference if possible.’24 (p. 4) | Global health: as an option is often self-selected and not compulsory and is therefore aimed at learners who already are aware of the concepts related to global health. | Global health—to be a compulsory component of social justice and social determinants that impact health. |
| … ‘I oversee & co-founded a program in which we implement community organizing principles into the PCMH [patient centered medical home] … Over the last 2 years, we worked on the community-identified issue of affordable housing and developed three campaigns… the greatest impact to me is flattening the hierarchy in the clinic so that patients are empowered to created change with the clinic’s support.’46 (p. 589) | Health systems reform and public health initiatives: social justice work requires learners to develop and apply knowledge outside of the confines of the clinical setting and lived experiences provided a foundation for this. | Learners understood social justice from experiential learning. |
| ‘My experience was an extremely valuable source of learning which broadened my understanding of social responsibility in medicine beyond what I could have achieved in a classroom or local community setting. It was different, for instance, from structured office visits to the underserved Downtown Eastside [in Vancouver] because rather than just being exposed to such a population, I was [living with them] for two months.’20 (p. 980) | Teaching process and method: important methods that were non-traditional were included. | Learning process: non-core activities include community-engaged research, service learning activities, guest lecturers’ perspectives on their experience, an assessment tool that provided the assessment and instant feedback required in the learning process. |
HRSJ, human rights and social justice.