A Society of General Internal Medicine Position Statement on the Internists’ Role in Social Determinants of Health

Byhoff, Elena; Kangovi, Shreya; Berkowitz, Seth A.; DeCamp, Matthew; Dzeng, Elizabeth; Earnest, Mark; González, Cristina M.; Hartigan, Sarah; Karani, Reena; Memari, Milad; Roy, Brita; Schwartz, Mark D.; Volerman, Anna; DeSalvo, Karen B.

doi:10.1007/s11606-020-05934-8

Cited by 46 publications

(36 citation statements)

References 50 publications

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“…There has been growing interest among national health care organizations for health systems to address patients’ unmet social needs to reduce health disparities. 27 , 28 , 29 , 30 , 31 Recognizing the need to prepare health care professionals to understand and mitigate the social and economic factors that lead to health disparities, medical schools are increasingly interested in implementing curricula to train students about the SDH and health disparities. 11 , 12 , 13 Despite the growing interest, few curricula are currently available, and the curricula that have been developed are often limited in duration (<6 weeks) or only offered to a select number of students.…”

Section: Discussionmentioning

confidence: 99%

Association of a Health Equity Curriculum With Medical Students’ Knowledge of Social Determinants of Health and Confidence in Working With Underserved Populations

et al. 2021

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IMPORTANCE National organizations recommend that medical schools train students in the social determinants of health. OBJECTIVE To develop and evaluate a longitudinal health equity curriculum that was integrated into third-year clinical clerkships and provided experiential learning in partnership with community organizations. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study was conducted from June 2017 to October 2020 to evaluate the association of the curriculum with medical students' selfreported knowledge of social determinants of health and confidence working with underserved populations. Students from 1 large medical school in the southeastern US were included. Students in the class of 2019 and class of 2020 were surveyed at baseline (before the start of their third year), end of the third year, and graduation. The class of 2018 (No curriculum) was surveyed at graduation to serve as a control. Data analysis was conducted from June to September 2020. EXPOSURES The curriculum began with a health equity simulation followed by a series of modules. The class of 2019 participated in the simulation and piloted the initial 3 modules (pilot), and the class of 2020 participated in the simulation and the full 9 modules (full). MAIN OUTCOMES AND MEASURES A linear mixed-effects model was used to evaluate the change in the self-reported knowledge and confidence scores over time (potential scores ranged from 0 to 32, with higher scores indicating higher self-reported knowledge and confidence working with underserved populations). In secondary analyses, a Kruskal-Wallis test was conducted to compare graduation scores between the no, pilot, and full curriculum classes. RESULTS A total of 314 students (160 women [51.0%], 205 [65.3%] non-Hispanic White participants) completed at least 1 survey, including 125 students in the pilot, 121 in the full, and 68 in the no curriculum classes. One hundred forty-one students (44.9%) were interested in primary care. Total self-reported knowledge and confidence scores increased between baseline and end of clerkship (15.4 vs 23.7, P = .001) and baseline and graduation (15.4 vs 23.7, P = .001) for the pilot and full curriculum classes. Total scores at graduation were higher for the pilot curriculum (median, 24.0; interquartile range [IQR], 21.0-27.0; P = .001) and full curriculum classes (median, 23.0; IQR, 20.0-26.0; P = .01) compared with the no curriculum class (median, 20.5; IQR, 16.25-24.0). (continued) Key Points Question Is a longitudinal health equity curriculum associated with improved self-reported knowledge of the social determinants of health and confidence with working with underserved populations among US medical students? Findings In this cohort study of 314 students, self-reported knowledge and confidence scores significantly increased over time for participants in both the pilot and full curriculum classes. Compared with students not exposed to the curriculum, those in the pilot and the full curriculum classes had significantly higher scores at graduation. Me...

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Section: Discussionmentioning

confidence: 99%

Association of a Health Equity Curriculum With Medical Students’ Knowledge of Social Determinants of Health and Confidence in Working With Underserved Populations

et al. 2021

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“…Health services researchers specializing in qualitative methods have suggested a very similar approach without using the term abductive . For example, the seminal paper on qualitative methods by Elizabeth Bradley, Leslie Curry, and Kelly Devers recommended taking an “integrated approach [that] employs both inductive (ground‐up) development of codes as well as a deductive organizing framework for code types.” 51 …”

Section: Methodsmentioning

confidence: 99%

“…This is consistent with the standard academic usages in health services research and sociology. [52][53][54] In the academic literature, medicalization is the process by which human or social problems become seen as medical problems and are designated as such. For an organization to become medicalized, therefore, is to give its work a medical framing.…”

Section: Establishing a Knowing-doing Gap: Cbos Value Their Distinctimentioning

confidence: 99%

Money Moves the Mare: The Response of Community‐Based Organizations to Health Care's Embrace of Social Determinants

Taylor

Byhoff

2021

Milbank Quarterly

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Health policies that encourage health and social integration can induce community-based organizations (CBOs) to adopt new ways of working from health care organizations, including their language, staffing patterns, and metrics. These changes can be explained by CBOs' perceptions that health care organizations may provide new sources of revenue. r While the welfare implications of these changes are not yet known, policymakers should consider balancing the benefits of professionalizing CBOs against the risks of medicalizing them. Context: Recent health policies incentivize health care providers to collaborate with community-based organizations (CBOs), such as food pantries and homeless shelters, to address patients' social determinants of health (SDOH). The perspectives of health care leaders on these policy changes have been studied, but the perspectives of CBO managers have not. Methods: Our research question was: How are CBOs in Massachusetts perceiving and responding to new Medicaid policies that encourage collaboration between health care organizations and CBOs? We interviewed 46 people in leadership positions at CBOs in Massachusetts for approximately an hour each. We analyzed these data abductively, meaning that we iterated between inductively coding transcripts and consulting existing theories and frameworks. Findings: We found evidence of a knowing-doing gap among CBOs. Even though CBOs value their distinctiveness and autonomy from health care, they

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“…As an example of many health effects of systemic racism (to include stress‐induced hypertension and its “downstream” effects, lower birth weights, lower rates of renal transplantation, historically unethical experimentation, etc. ), 1,2 African‐American men are up to 3.5 times more likely than their White‐American counterparts to be slain by police 3 . According to Edwards et al 4 in a recent study, one in 1,000 African‐American men will die at the hands of a law enforcement officer—twice the rate of men in general in the United States.…”

mentioning

confidence: 99%

“…We pledge to address the social and moral determinants of health that adversely affect our patients and their outcomes 2,5 …”

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confidence: 99%

The Antiracist, Propatient Pledge of Emergency Medicine

Martin

Hargarten

2020

Academic Emergency Medicine

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A Society of General Internal Medicine Position Statement on the Internists’ Role in Social Determinants of Health

Cited by 46 publications

References 50 publications

Association of a Health Equity Curriculum With Medical Students’ Knowledge of Social Determinants of Health and Confidence in Working With Underserved Populations

Association of a Health Equity Curriculum With Medical Students’ Knowledge of Social Determinants of Health and Confidence in Working With Underserved Populations

Money Moves the Mare: The Response of Community‐Based Organizations to Health Care's Embrace of Social Determinants

The Antiracist, Propatient Pledge of Emergency Medicine

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