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Incorporating social determinants of health (SDOH) into the primary curriculum has become a priority for many Canadian medical schools, which have long been tasked by Health Canada to ensure that future prescribers can work confidently with diverse patient populations.

Especially during the first and second years of medical school, most SDOH-related courses are didactic. But through a combination of initiative, forethought, and determination, two first-year medical students at the University of Ottawa’s Faculty of Medicine, Ottawa, have created a strategy to enhance this education: the boots-on-the-ground, Student-led Health Initiative Partnership (SHIP) Clinic.

SHIP is based in the Office of Social Accountability within the University of Ottawa’s Faculty of Medicine and was officially launched in January 2025. The goal, explained SHIP co-founder Nicole Wisener, was to identify ways in which students could support the services delivered by organizations that already were embedded into Ottawa communities. The added benefit would be to help medical students enhance their clinical skills.

“I wanted to find a way for medical students to step outside the classroom and learn what social medicine means and learn the challenges faced by disadvantaged communities,” Wisener told Medscape Medical News. “The best way to learn is by speaking with people who are actually facing these issues; that’s what the SHIP Clinic was born out of.”

“Many of these students have come into medical school wanting to make changes to SDOH or reflecting on their importance in health,” said Claire Kendall, MD, PhD, associate dean of social accountability at the University of Ottawa and family physician at Bruyère Health Academic Family Medicine in Ottawa. “Exposing them as early as possible is critical.” 

Forging Community Partnerships

One of the keys to the early successes of the SHIP program has been its collection of community partnerships. Wisener said that she and co-founder Emily Liang initially identified and approached several organizations to discuss their needs and where medical students might fill resource gaps.

“One of our concerns was to ensure that the program was both sustainable and beneficial to the community or community partner, as well as the students,” said Wisener. “As much as we wanted to have medical students helping out in these spaces, we also understood the need to find a balance between what partners were comfortable with and had the capacity for and how we could help boost their productivity.”

This consideration is important for other schools that might be considering similar programs. 

“It can be a resource win, but we should not make the assumption that it’s a win for all organizations,” noted Kendall. “We need to make sure that we understand the organization’s context well so that students can be of service.” There must be “a mutual understanding of their skills and skill levels, how much supervision they need, and how their presence can be embedded into existing processes and caring for patients,” she added.

Aiding Unhoused Patients

Programs like SHIP can be a boon by freeing up resources and enabling community partners to devote their attention elsewhere. They can also supplement ongoing efforts in ways that partners might not be able to afford or organize.

Partnering with SHIP was a timesaver, Simon Hatcher, MD, a psychiatrist at the Ottawa Hospital, a scientist at the Ottawa Hospital Research Institute, and acting chair of psychiatry at the University of Ottawa, told Medscape Medical News.

“For me, it’s a way to spread myself a bit further. An hour of time supervising medical students translates into at least 2 hours of patients getting counseling; they provide supportive therapy for people who otherwise would not receive it.” Hatcher also works part-time at Ottawa Inner City Health, an organization that provides physical and mental healthcare services to unhoused patients. Partnering with SHIP is “a win-win situation,” he added.

For the inaugural year, Hatcher worked with two students who provided supportive counseling to patients in two supportive housing units. These patients initially were ambivalent about working with the students: Nearly every unhoused person has a history of trauma and is wary of relationships, he said. Ultimately, the patients were quite grateful. The care “was something they wouldn’t otherwise be able to access,” said Hatcher.

Ananya Toal was one of Hatcher’s volunteer students. She told Medscape Medical News that what drew her to apply to SHIP was the opportunity to meld her passion for advocacy with lessons learned in the classroom and translate those lessons into practice.

“Essentially, I provided supportive counseling for individuals who’ve experienced substance use disorders or had been in the criminal system,” said Toal. “We’d talk about their lives, future goals, and if they were willing, past traumas and how they shaped their reactions or the person they had become,” she said.

Her favorite part of the program was the opportunity to have a one-on-one, uninterrupted interaction with the patient for an hour every week. “When we’re going into clinics and talking to patients, even as medical students, we don’t get to spend much time with them. It was nice to be able to sit down, hear their perspective, and discuss things more holistically, which is something the system doesn’t really offer,” said Toal.

A Growing Program

SHIP is preparing to launch an increased capacity program that will run from September 2025 to June 2026. Though she is unclear as to the number of community partners that will be added to the current roster (which includes Ottawa Inner City Health, Centretown Community Health Centre, Eastern Ottawa Resource Centre, and Carlington Community Centre), there are plans to increase the number of students from 17 to 35. Regardless, SHIP will continue to focus on Ottawa’s underserved communities.

“I’ve learned from community members what health equity and SDOH are and how they intersect to affect health,” said Wisener. “By having a bigger world view and a more compassionate view of the different things that patients go through in their lives, we can provide much higher quality care for them.”

Kendall stressed that SDOH have a major influence on patients’ health. “The places where people live, work, and play are directly associated with how healthy they are. Our students will need a strong foundation for addressing SDOH through socially oriented, community-partnered, and reflective practice,” she said.

SHIP might also be a strategy for responding to the family medicine crisis in Canada, said Kendall.

“It’s a way of reintroducing compassion into medicine,” added Hatcher.

Wisener, Kendall, Liang, and Hatcher reported having no relevant financial relationships.

Liz Scherer is an independent health journalist who frequently writes about Canadian and global health challenges.