Agents of change: preparing Scotland’s future doctors to lead health system transformation

Title: Agents of Change: Preparing Scotland’s Future Doctors to Lead Health System Transformation
Authors: Angela Flynn1, Andrew O’Malley1, Jayne Stuart1, Angela Millar2, Phil Walmsley1, Lucy Denvir1
Affiliations: 1St Andrews University, 2 University of Dundee
Abstract:
Aim
The Agents of Change (AoC) strand within the ScotGEM undergraduate medical curriculum prepares future doctors to lead transformational change in healthcare. By integrating cross-cutting themes of sustainability, leadership, research methods, realistic medicine, and data science, AoC equips students to respond to individual patient needs and address broader systemic challenges. The curriculum fosters person-centred, evidence-informed, and innovative practice while promoting equity and system-level thinking.
Methods
AoC is delivered through a spiral curriculum, combining experiential and structured learning, influenced and delivered by Generalist Clinical Mentors (GCMs), academic faculty, and community partners. Key elements:
1.Change Tools – Students use tools such as process mapping, driver diagrams, stakeholder analysis, and PDSA cycles to support system redesign and service improvement through real-world application of quality improvement (QI) and community engagement projects.
2.Leadership Development – Reflective practice and experiential learning support the development of core competencies in communication, collaboration, influence, and ethical decision-making.
3.Data Science – Students are trained in the fundamentals of research design, critical appraisal, and data interpretation. They explore the role of data science in medicine, gaining skills in using health informatics and analytics to inform clinical care and system improvement.
4.Sustainability – Students are encouraged to consider environmental, economic, and social sustainability in clinical decision-making and service delivery.
5.Realistic Medicine – Through clinical casework and prescribing education, students learn to practice patient-centred care, reduce harm and waste, and apply the principles of person-centred, evidence-based practice.
Results
Approximately 286 student-led projects using transformational change tools have been completed in 2023-2024, achieved tangible outcomes, including improved prescribing practices, enhanced digital health implementation, and more equitable service access. Students demonstrate increased confidence in data-informed decision-making and clinical problem-solving. Leadership skills have been strengthened through interprofessional collaboration and presentations. Embedding sustainability and realistic medicine has reinforced holistic, values-driven care.
Conclusions
The AoC curriculum provides a pioneering model for medical education that goes beyond clinical competence, embedding the skills, tools, and mindsets required for transformational change. Equipping future doctors with capabilities in leadership, sustainability, research, data science, and person-centred care, the programme supports a forward-thinking, adaptable healthcare workforce ready to improve outcomes for patients and populations across Scotland.
Patient and Public Involvement:
Curriculum development and delivery were informed by NHS partners, academic institutions and community contributors.
References:
The ScotGEM programme, supported by the Scottish Government, participating NHS boards, academic partners (Universities of St Andrews and Dundee), and community organisations.
Keywords:
Sustainability, Health System Transformation, Realistic Medicine, Leadership