These enhance domains are the ones that are the largest stretch away from the foundation programme. They ask you to think a little more about the ‘bigger picture’ and provide you with a wider context for developing your leadership and advocacy skills. Because the aims are so broad, they have been grouped together to allow you to choose the areas that interest you the most. We have briefly outlined each section of the module below.
Social Justice and Health Equity
“If medicine is to fulfil her great task then she must enter the political and social life.”– Rudolph Virchow
We are practicing medicine in one of the most unequal societies in Europe. We know that systemic inequality between different groups leads to poor outcomes, most of which are avoidable and unfair. This was starkly demonstrated by the COVID-19 pandemic.
As healthcare professionals, we are in a unique position to highlight and work towards improving inequality. In countries like the UK this is essential. This section of the module starts by asking you to think about the interplay between the social determinants of health and inequality, along with the concepts of advocacy, allyship and activism. It will help you work out where your work as a doctor fits into the wider system, and things you can do to reduce inequality in your daily practice.
Environmental Sustainability
We are on the precipice of an environmental disaster. The world is heating, its population is growing and we face ever increasing pressures on our natural resources.
As healthcare workers, we will be on the frontline of dealing with the healthcare issues that are caused by global warming. But we also work in a sector that is contributing to this crisis, with 4.4% of all global emissions coming from health systems. This domain asks you think about how to reduce waste in your day-to-day practice, how we can work as a system to improve our environmental sustainability and how we can communicate this to our colleagues and patients.
System Working
Our healthcare system is complex, with many different services that fit together to provide care. As society has changed, these traditional models for providing care do not always meet our patients needs. This can result in disjointed and inefficient care. These compartmentalised models also stop us making inroads into population health issues and can worsen health inequalities.
In order to improve the care our health service provides, we need to understand the system and how it works. We also need to know how to work with a wide variety of professionals and communicate effectively across organisational boundaries. By building these skills, this module will help you influence the system and develop solutions to issues we come across.
Resources
This a is a list of resources, divided by the main outcomes of the module. We have tried to keep them as varied as possible, and you will find articles, eLearning, videos and podcasts that are relevant to the domain. The health inequality area of this module has a lot of cross over with the population health module. You will find an overlap with the resources listed. It may be that you decide to focus on different areas if you complete both.
You can pick the resources that interest you most, and you are more than welcome to find your own too! If you find something that you think would be helpful to share, feel free to let us know here.
Module Basics
– The Enhance Guide for Foundation Doctors (15 minute read) gives an excellent overview of the Enhance programme with links to other useful resources
– The Enhance Handbook (30 minute read for section) is an in-depth document that gives an overview of the whole programme, along with describing the six enhance domains in detail. You can access individual sections or a PDF of the whole handbook via this page
– The module workbook (17 minute read)
– The pre- and post- module self assessment matrix (2 minute read)
– The evidencing engagement form (2 minute read)
– The REAL form is now on the Horus ePortfolio, accessed here
Recognising vulnerable individuals
– Oliver McGowan training on learning disability and autism (various) is a package put together with the help of Oliver’s family. Oliver died in NHS care, in part due to a misunderstanding of his autism. This eLeaning talks about his story and what we can learn from it
– Mencap resources (various) has information for healthcare professionals who care for people with learning disabilities. It also has information for patients and a link to their ‘death from indifference’ report
– Modern slavery eLearning (various) from eLearning for life gives you the basic information you need to recognise possible victims of modern slavery
– Identifying domestic abuse (28 minute read) gives ten tips for recognising domestic abuse and how to approach this with patients. Whilst it is designed for GPs it also has useful information for people working in secondary care
– Screening for interpersonal violence (40 minute eLearning) is a module on recognising and screening for domestic violence. It is designed for nurses but is useful for all healthcare professionals
Understanding the social determinants of health
– Health inequalities in a nutshell (3 minute read) is a visual document from the King’s Fund that outlines health inequalities in the UK
– What is health inequality (36 minute read) is an article from the Kings Fund that gives some clear definitions and UK differences in health outcomes for all sorts of groups
– Health disparities and inequalities (40 minute read) is a UK government document that explains healthcare inequality and talks about how we can improve services. It is a really good introduction to some of these concepts
– The relationship between poverty and NHS services (35 minute read) is an article from the Kings Fund which talks about the link between poverty, ill health and access to healthcare
– Behind the Headlines: the unequal impact of the cost of living crisis (15 minute read)- This National Voices report collates patient experiences of the cost of living crisis and how this has affected their health
– MBRRACE-UK maternal mortality report (5 minute read) gives clear data about maternal mortality being worse for black and asian women compared to their white counterparts. This Lancet opinion piece discusses racism and maternal health too
– Black maternal healthcare (50 minute podcast) which discusses how to bridge the gaps between black mothers and healthcare services. This is also available on Spotify here and Apple here
– Anti-racism, leadership and the courage to speak out (30 minute podcast) is also available on Spotify and Apple podcasts
– BMJ racism in medicine issue (various) is a special issue that discusses a broad range of issues, from discriminatory AI to issues in medical training. It also has several interviews with experts
– Sickle cell (30 minute eLearning) is a module from ELFH about the equality gaps in care for sickle cell disease
– Kings Fund work on LGBTQAI+ healthcare (various articles) summarises the main data from the group on sexuality and gender
– Disclosure (1 hour 47 minute watch, Netflix login required) is a Netflix film that talks about the experience of trans people in America from a historical and current perspective
– A guide to pronouns (5 minute read) is a quick read from Stonewall on using peoples pronouns correctly
– Women in pain (7 minute read) is a Harvard health blog that outlines why women are often taken less seriously in healthcare settings
– What women want (40 minute podcast) is a podcast from the Kings Fund about women’s health inequalities. This is also available on Spotify and Apple
– Why women feel unheard (18 minute read, links to other resources) is a summary of evidence from the NIHR about gender inequality in healthcare and the reasons women often feel that they are not listened to
– Raising the profile of men’s health (7 minute read) talks about the gender gap between men’s and women’s health
– Core20plus5 (30 minute eLearning) is an eLearning for life module that focuses on the main areas that contribute to health inequality
– Death by indifference (1 hour, but you can read various sections) is a report from Mencap which examines the deaths of several people with learning disabilities in hospital. They do this through case studies and raising specific questions for you to reflect on. This is a difficult but important read
– Food for thought; how diet culture is damaging our bodies (14 minute watch) is a TEDx talk about our attitudes to weight and size
Inclusive practice and promoting social justice
– How can intersectionality further understanding on health inequalities (4 minute watch) is a video about the basics of intersectionality and how this affects healthcare
– Inclusive communication guide (40 minute read) is a document from Kings College London about using inclusive language when treating LGBTQAI+ patients
– What can be done to tackle LGBTQAI+ health inequalities (34 minute podcast) can also be found on Spotify and Apple
– Delivering race equality in medicine (1 hour 10 minutes) is a report from the BMA that outlines the issues faced by BAME patients and doctors, as well as what we can do to improve this
Environmental sustainability
– Carbon footprint calculator (five minute quiz) can help you calculate your carbon footprint and compare it to the average person in the UK
– 10 things a doctor can do to combat climate change (various) is a resource from the RCP that talks you through some practical steps you can take
– Why you should clean out your medicine cabinet (14 minute watch) is a TEDx talk about the massive climate impact of medications (up to 25% of the total NHS carbon footprint) and how we can improve our carbon footprint in this area
– Why the climate crisis threatens our health (16 minute watch) is a talk by Nathan Hudson Peacock for TEDx about his experiences of the climate crisis and our role in trying to stop it
– Health inequalities and climate change (28 minute podcast) talks about global warming from a healthcare perspective
– The EAT-Lancet planetary health diet (various) is a blueprint for sustainable eating. Food production is one of the biggest drivers of climate change. This website outlines this evidence-based diet that is optimal for both health and the planet, reducing climate change and illness. It recommends lots of plant-based proteins but is not a vegan diet
– Let’s rethink food (30 minute listen) is a podcast that outlines the EAT-Lancet report in a way that is easy to understand
– Surfers against sewage (various) is a website dedicated to reports on sewage discharges into the sea, along with how we can help. There are many events in Sussex and Kent if you would like to get involved
– Surfing was my life (5 minute read) is an account from a surf teacher who has long term illness that is likely due to sewage discharge into the sea
– Greener Practice resource page (various) has lots of useful links to improving the sustainability of your practice. There are also lots of resources for sustainable QI projects
– Greener Practice action page (various) has links to how you can work to improve the environmental impact of your practice and act as an advocate for your community
System working
– Learning from excellence (various) is a brilliant initiative that looks at how we can acknowledge good practice in the NHS. It has lots of practical guidance for bringing in a “greatix” system and how to analyse good practice and roll it out across a department or hospital
– How does the NHS in England work? (5 minutes 43 second watch) This video outlines the key organisations that make up the NHS and how they can collaborate with partners in the health and care system to deliver joined-up care
– What will patients get out of the NHS longterm plan (2 minute 40 second watch) is a video from NHS England about the practical impacts of the NHS longterm plan
– Getting it right first time (various) is an initiative that aims to improve the treatment and care of patients through in-depth review of services, benchmarking, and presenting a data-driven evidence base to support change
– Leadership in systems (various) is an eLearning programme from the NHS leadership academy
– Civility saves lives (various) is an initiative that looks at how we communicate with one another in a pressurised system