Integrating Social Determinants of Health Into Graduate Medical Education: A Call for Action

Abstract

Social determinants of health (SDH) are the major drivers of health and disparate health outcomes across communities and populations. Given this, the authors assert that competency in recognizing and mitigating SDH should become a vital component of graduate medical education in all specialties. Although the most effective approaches to educating trainees about SDH are uncertain, in this Invited Commentary, the authors offer several key principles for implementing curricula focusing on SDH. These include universalization of the material, integration into clinical education, identification of space for trainee introspection, clarification of specific competencies in identification and mitigation of SDH, and creation of robust faculty development programming. The authors highlight several examples of curricular approaches to SDH, touching on orientation, experiential learning, community-based and service-learning opportunities, interprofessional activities, and the hidden curriculum. The authors argue that all clinical trainees must learn to recognize and mitigate SDH and that doing so will allow them to achieve meaning and mastery in medicine and to better meet society's pressing health needs.

An Adapted Framework for Incorporating the Social Determinants of Health into Predoctoral Dental Curricula

“…11 Discussing the constructs of race, ethnicity, socioeconomic status, and gender and their impact on oral health is critical. To "universalize" in this context has two meanings: irst, to develop a set of core values, knowledge, and skills required for the entire oral health workforce to successfully provide the best possible treatment to all patients, and second, to implement those core values in both didactic and clinical teaching.…”

“…11 This reframing of the current health care model will require health professions educators to examine their curricula for any disparate SDH topics and to connect them to a broader narrative that includes health inequities, population health and diversity, and cultural competence. 11 This reframing of the current health care model will require health professions educators to examine their curricula for any disparate SDH topics and to connect them to a broader narrative that includes health inequities, population health and diversity, and cultural competence.…”

“…1 Deined by the World Health Organization (WHO) as "the conditions in which people are born, grow, work, live, and age and the wider set of forces and systems shaping the conditions of daily life," SDH are frequently the root cause of ill health and disease beyond the person's genetic makeup and medical treatment received. 10,11 Recently, Sabato et al provided an innovative case study using Tufts University School of Dental Medicine's interprofessional education program as a vehicle to highlight the importance of SDH as a mechanism to reduce health disparities. 3 Oral diseases like dental caries, periodontal disease, and oral cancer, along with concerns about access to dental care, are all impacted by social, political, and behavioral factors.…”

“…3 Oral diseases like dental caries, periodontal disease, and oral cancer, along with concerns about access to dental care, are all impacted by social, political, and behavioral factors. 10,11 Noting this challenge, the National Academies of Science, Engineering, and Medicine developed a conceptual framework that health professions educators can employ to incorporate SDH seamlessly into the learning continuum across their curricula. [4][5][6][7][8][9] An important initiative would be to include SDH in dental curricula to educate future dental providers to prioritize these non-medical factors when treating patients.…”

“…Relevant elements of SDH, such as the impact of poverty or race on health, are noted, but lack the necessary comprehensive connection to overall health or to the role that health care providers can play in reducing such disparities. 10,11 Recently, Sabato et al provided an innovative case study using Tufts University School of Dental Medicine's interprofessional education program as a vehicle to highlight the importance of SDH as a mechanism to reduce health disparities. 12 Medical, dental, nursing, and social work students participated in that program.…”