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

Abstract

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...

Effectiveness of alternative approaches to integrating the Social Determinants of Health into medical education: a systematic review

“…Of the eight curricula included in the review, six were from medical schools in the United States (10-16), one from the United Kingdom (U.K.) (17), and one from Israel (18). Seven programs aimed at medical students only (15)(16)(17)(18)(19)(20)(21), and only one curriculum was an inter-professional program covering medical students and other health professionals, including medical, nursing, pharmacy school, public health students, and social work students (23) A three-step review process was undertaken covering the structure of each curriculum (such as whether it was mandatory or not, the duration of the program), its content (the conceptual framework employed, which didactic methods were included, and the primary learning competencies focused on) and lastly whether the program was evaluated.…”

“…Five were integrated over an entire academic year (16- 19,22) ; one of the ve programs lasted 18 months (with a six-month preparation phase), and the remaining three varied between three and four months (21,23,24). Regarding timing, four SDOH curricula were for third and fourth-year medical students at the beginning of the clinical clerkship (17)(18)(19)24). The nal three programs focused on the rst-and second-year medical students (16, 21,22).…”

“…The Health equity curriculum (10) at the Wake Forest School of Medicine is based on the National Academic of Science, Engineering, and Medicine's Framework For educating Health Professionals to Address the Social Determinants of health which recommends incorporating SDOH teaching over three domains; education, community, and organisations collaboration. The education domain comprises four areas, collaborative learning, experiential learning, integrated curriculum, and continuing professional (5) The Interprofessional course at the University of South Carolina (23) integrated multiple frameworks.…”

“…(18,22,23) Another three courses used the same approach adding the student's re ection as a writing assay or oral presentation third modality. (19)(20)(21) On the other hand, the studentrun clinic course used the experiential learning method through the weekly student-run clinic. (16) Lastly, the U.K. SDOH curricula applied the innovative ipped classroom method, which includes pre-class learning resources and classroom discussion to enhance that knowledge.…”

“…(16,17) The analysis of each curriculum showed the following. The Wake Forest School of Medicine curricula (19)was evaluated based on three cohorts of 314 students. These cohorts included: the students who received the entire course (nine modules), the shorter course (three modules) and those who did not receive any teaching.…”