Missing the target? Teaching undergraduate medical students to “go upstream” and advocate on social determinants of health

We describe a pilot project aimed at teaching advocacy skills to pre-clinical medical students, using the lens of the social determinants of health. During the pilot, students were tasked with performing a mock deputation to a policymaker and writing an opinion editorial piece for a lay audience. Students excelled in identifying the relevant social and structural factors impacting health, yet demonstrated uncertainty about how to identify, approach and best influence stakeholders around policy change. To be effective health advocates, medical trainees require training in specific advocacy skills such as oral and written communication, however this alone may be insufficient. As future advocates, medical trainees must also acquire a specific skill set to navigate the complex political systems in which they will practice.