Learning social determinants of health through a home visiting course in the clinical years

Sagi, Doron; Spitzer-Shohat, Sivan; Schuster, Michal; Rier, David A.; Rudolf, Mary

doi:10.1016/j.pec.2020.05.002

Cited by 6 publications

(16 citation statements)

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“…Table 2 provides an overview of each SDOH curriculum, and its primary feature. Of the eight curricula included in the review, six were from medical schools in the United States [ 11 – 16 ], one from the United Kingdom (U.K.) [ 17 ], and one from Israel [ 18 ]. Seven programs were aimed at medical students [ 11 , 12 , 14 – 18 ], 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 [ 13 ].…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of alternative approaches to integrating SDOH into medical education: a scoping review

et al. 2023

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Background There is increasing recognition of including social determinants of health (SDOH) in teaching for future doctors. However, the educational methods and the extent of integration into the curriculum vary considerably—this scoping review is aimed at how SDOH has been introduced into medical schools' curricula. Methods A systematic search was performed of six electronic databases, including PubMed, Education Source, Scopus, OVID (Medline), APA Psych Info, and ERIC. Articles were excluded if they did not cover the SDOH curriculum for medical students; were based on service-learning rather than didactic content; were pilot courses, or were not in English, leaving eight articles in the final study. Results The initial search yielded 654 articles after removing duplicates. In the first screening step, 588 articles were excluded after applying inclusion and exclusion criteria and quality assessment; we examined 66 articles, a total of eight included in the study. There was considerable heterogeneity in the content, structure and duration of SDOH curricula. Of the eight included studies, six were in the United States(U.S.), one in the United Kingdom (U.K.) and one in Israel. Four main conceptual frameworks were invoked: the U.S. Healthy People 2020, two World Health Organisation frameworks (The Life Course and the Michael Marmot's Social Determinants of Health), and the National Academic of Science, Engineering, and Medicine's (Framework For educating Health Professionals to Address the Social Determinants of Health). In general, programs that lasted longer appeared to perform better than shorter-duration programmes. Students favoured interactive, experiential-learning teaching methods over the traditional classroom-based teaching methods. Conclusion The incorporation of well-structured SDOH curricula capturing both local specification and a global framework, combined with a combination of traditional and interactive teaching methods over extended periods, may be helpful in steps for creating lifelong learners and socially accountable medical school education.

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Section: Resultsmentioning

confidence: 99%

Effectiveness of alternative approaches to integrating SDOH into medical education: a scoping review

et al. 2023

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“…Incorporating communication skills into this patient care course, the clinical year students do not learn these skills as 'stand-alone', but within the context of real life. By meeting patients in hospital and at home, students had the opportunity to witness the impact of health literacy on patients' health, its effect on health inequities and the role of clear communication in tackling them [26,27].…”

Section: Discussionmentioning

confidence: 99%

“…Many patients have inadequate Hebrew, the primary language spoken in Israel, either because they are Arab or are immigrants [29]. The ETGAR program is successful in involving disadvantaged patients in terms of these parameters [27].…”

Section: Setting and Participantsmentioning

confidence: 99%

“…Through writing plain language discharge letters to real patients during their transition in care and sharing them in the home setting, ETGAR aims to firstly provide students with written communication skills training, and also to promote the understanding of health literacy and other social determinants affecting patient's health and health inequity [14,26,27].…”

Section: Introductionmentioning

confidence: 99%

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Teaching plain language to medical students: improving communication with disadvantaged patients

et al. 2021

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Background Low health literacy underpins health inequality and leads to poor adherence to medical care and higher risk of adverse events and rehospitalization. Communication in plain language, therefore, is an essential skill for health professionals to acquire. Most medical education communication skill programs focus on verbal communication, while written communication training is scarce. ETGAR is a student delivered service for vulnerable patients after hospital discharge in which, amongst other duties, students ‘translate’ the medical discharge letters into plain language and share them with patients at a home visit. This study ascertains how this plain language training impacted on students’ written communication skills using a tool designed for purpose. Methods Students, in pairs, wrote three plain language discharge letters over the course of a year for patients whom they encountered in hospital. The students handed over and shared the letters with the patients during a post-discharge home visit. Structured feedback from course instructors was given for each letter. An assessment tool was developed to evaluate students’ ability to tell the hospitalization narrative using plain and clear language. First and last letters were blindly evaluated for the entire cohort (74 letters; 87 students). Results Students scored higher in all assessment categories in the third letters, with significant improvement in overall score 3.5 ± 0.8 vs 4.1 ± 0.6 Z = -3.43, p = 0.001. The assessment tool’s reliability was high α = 0.797, it successfully differentiated between plain language categories, and its score was not affected by letter length or patient’s medical condition. Conclusions Plain language discharge letters written for real patients in the context of experience-based learning improved in quality, providing students with skills to work effectively in an environment where poor health literacy is prevalent. ETGAR may serve as a model for learning written communication skills during clinical years, using the assessment tool for formative or summative evaluation.

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“…We have already reported our investigation on two major educational tools developed and implemented in ETGAR: the post discharge home visit [22] and plainlanguage discharge letter [23]. The present study aimed a-to demonstrate the use of the social ecological model for developing a social disparity educational course.…”

Section: Introductionmentioning

confidence: 95%

A social ecological approach to promote learning health disparities in the clinical years: impact of a home-visiting educational program for medical students

2022

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Background There is consensus that medical schools have a duty to educate students about social determinants of health (SDOH) and equip them with skills required to ameliorate health disparities. Although the National Academy of Medicine (NAM) urged the development of experiential long term programs, teaching is usually conducted in the pre-clinical years or as voluntary courses. ETGAR a required health disparities course, based on the social ecological model, was initiated to answer the NAM call. This study aimed to ascertain the course impact on students learning of SDOH and health disparities. Methods Students during their first clinical year cared for four patients in their transition from hospital back home, one patient in each internal medicine, surgery, pediatrics and obstetrics/gynecology rotation. The students home-visited their patients after meeting them in hospital and preparing a plain language discharge letter. Training session prior to the course, a tutorial in each rotation, and structured feedback gave the educational envelope. Mixed methodology was employed to evaluate the course impact. Quantitative data collected by students during the home-visit: patients’ characteristics and quality and safety of the transition back home using the Medication Discrepancy Tool and Care Transition Measure questionnaire. Stakeholders’ views were collected via interviews and focus groups with students representing all affiliated hospitals, and interviews with heads of departments most involved in the course. Results Three hundred six students in three academic years, between October 2016–July 2019, completed home visits for 485 disadvantaged patients with improvement in patients’ knowledge of their treatment (3.2 (0.96) vs 3.8 (0.57), Z = -7.12, p < .0001) and identification of medication discrepancies in 42% of visits. Four themes emerged from the qualitative analysis: contribution to learning, experience-based learning, professional identity formation, and course implementation. Conclusions ETGAR was perceived to complement hospital-based learning, making students witness the interaction between patients’ circumstances and health and exposing them to four patients’ environment levels. It provided a didactic framework for promoting awareness to SDOH and tools and behaviors required to ameliorate their impact on health and health disparities. The course combined communication and community learning into traditionally bio-medical clinical years and serves as a model for how social-ecology approaches can be integrated into the curriculum.

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Learning social determinants of health through a home visiting course in the clinical years

Cited by 6 publications

References 25 publications

Effectiveness of alternative approaches to integrating SDOH into medical education: a scoping review

Effectiveness of alternative approaches to integrating SDOH into medical education: a scoping review

Teaching plain language to medical students: improving communication with disadvantaged patients

A social ecological approach to promote learning health disparities in the clinical years: impact of a home-visiting educational program for medical students

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