Teaching inclusion health principles: What medical students must learn to be prepared to work with marginalized populations

Introduction: Traditional medical education emphasizes biomedical sciences but often underprepares learners for the challenges of working with medically underserved and excluded populations. An Inclusion Health elective was developed to integrate training in the social determinants of health and the skills necessary to provide high-quality care in low-resource environments. Pedagogical frameworks: The course draws on five complementary frameworks: service learning, problem-based learning, case-based learning, cultural humility, and experiential learning, to deepen students' understanding of exclusion in health care and to equip them with both clinical and relational skills. Together, these frameworks collectively foster critical reflection, adaptability, and a systems-level perspective. Learning environment: The elective combines classroom seminars, community-based clinical experiences, and applied learning assignments. Students work alongside outreach teams, healthcare for the homeless clinics, and social service organizations, developing practical skills in environments with limited referral networks and constrained resources. Assessment: Evaluation includes reflective writing, clinical supervision evaluations, faculty and community partner feedback, and concludes with a standardized patient assessment and reflection session, measuring cognitive and affective learning outcomes. Discussion: The program demonstrates how integrating theory-driven pedagogy with immersive, community-engaged learning can address critical educational gaps, preparing future clinicians to navigate and challenge structural inequities. Acknowledgment of constraints: Implementation faced challenges, including scheduling within the medical curriculum, sustaining community partnerships, and evaluating long-term impacts on student practice patterns.