An Experiential Resident Module for Understanding Social Determinants of Health at an Academic Safety-Net Hospital

Abstract

Introduction: Half of the U.S. population has chronic illness. Many disparities exist in health care for management of chronic disease among poorer individuals, including decreased access to healthy foods, homelessness, and difficulty navigating large hospital systems due to low health literacy. A survey of resident physicians found significant gaps in preparedness to provide cross-cultural care. Education is needed to promote consideration of patients' social and cultural barriers in managing disease and navigating the health care system. This module was created as an introduction to social determinants of health, and highlights disparities in access to healthy food, water, shelter, and medical care in a sample of the residents' own continuity clinic patient panel. Methods: We designed this experiential module to help internal medicine residents at an urban institution better understand how social constructs might hinder patient health. Activities were chosen by learners from a list of options, and carried out in small groups during a half day of protected time. We used reflective writing exercises to elicit resident thoughts about the module. Results: Thirty-nine second-year residents participated in the module. Following the course, 41% of residents submitted reflective statements about their experience. Reflective responses suggest an enhanced appreciation for social determinants of health, a sense of empowerment to advocate for better patient resources, and an appreciation for systems-level factors that play a role in social determinants of health. Discussion: Our results demonstrate that a short, experience-based module can impact resident attitudes about social determinants and improve advocacy around identifying community resources.

Structural Competency: Curriculum for Medical Students, Residents, and Interprofessional Teams on the Structural Factors That Produce Health Disparities

“…Structural competency builds upon existing social determinants of health, cultural competency, and cultural humility curricular efforts. 1,4,5,[22][23][24][25][26][27] In contrast to many curricula framed in terms of the social determinants of health that describe the existence of, but not the historical and contemporary drivers of, health disparities, structural competency situates these social determinants within a broader structural context. For example, a structural competency approach not only characterizes the epidemiology of racial health disparities-it examines the structures that have created and sustain racial inequity (i.e., structural racism).…”

Using simulation to increase resident comfort discussing social determinants of health

“…Residents found our curriculum useful for learning about community resources and practicing clinically-oriented conversations related to SDoH as has been described previously [ 7 , 9 , 34 ]. Klein et al also reported trainees experiencing impactful realizations about family circumstances, reflecting about self-perceptions and practices, and gaining knowledge regarding community-based resources after a two-week curriculum combining didactics and immersive experiences involving poverty and provision of health care to underserved populations [ 9 ].…”

“…Historically, pediatric trainees have inadequate training to identify and intervene on the unmet needs associated with SDoH [ 6 ]. Recent educational interventions focused on improving the knowledge of and attitudes towards addressing SDoH in a clinical setting have shown promising results [ 7 , 8 ]. Didactic- and immersion-based efforts to provide training to pediatric residents on SDoH have resulted in improved trainee knowledge and comfort with discussing social determinants of health [ 9 ].…”

Untold stories: Emergency medicine residents’ experiences caring for diverse patient populations

“…28 Carefully designed curriculum has been developed in other specialties to promote conversation related to racism and health disparities on the wards and in didactics. 29,30 The unique ED environment may require the development of brief tools to aid residency programs in debriefing common difficult patient interactions and prompt provider reflection on personal identity differences, especially in lowresource settings.…”