<p>Addressing the Social Determinants of Health in Undergraduate Medical Education Curricula: A Survey Report</p>

Abstract

Purpose: Social determinants of health (SDH) are recognized as important factors that affect health and well-being. Medical schools are encouraged to incorporate the teaching of SDH. This study investigated the level of commitment to teaching SDH; learning objectives/ goals regarding student knowledge, skills, and attitudes; location in the curriculum and teaching strategies; and perceived barriers to teaching SDH. Methods: A team from the American Medical Association's Accelerating Change in Medical Education Consortium developed a 23-item inventory survey to document consortium school SDH curricula. The 32 consortium schools were invited to participate. Results: Twenty-nine (94%) schools responded. Most respondents indicated the teaching of SDH was low priority (10, 34%) or high priority (12, 41%). Identified learning objectives/ goals for student knowledge, skills, and attitudes regarding SDH were related to the importance of students developing the ability to identify and address SDH and recognizing SDH as being within the scope of physician practice. Curricular timing and teaching strategies suggested more SDH education opportunities were offered in the first and second undergraduate medical education years. Barriers to integrating SDH in curricula were identified: addressing SDH is outside the realm of physician responsibility, space in curriculum is limited, faculty lack knowledge and skills to teach material, and concepts are not adequately represented on certifying examinations. Conclusion: Despite the influence of SDH on individual and population health, programs do not routinely prioritize SDH education on par with basic or clinical sciences. The multitude of learning objectives and goals related to SDH can be achieved by increasing the priority level of SDH and employing better teaching strategies in all years. The discordance between stated objectives/goals and perceived barriers, as well as identification of the variety of strategies utilized to teach SDH during traditional "preclinical" years, indicates curricular areas in need of attention.

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

“… 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. 12 , 13 Our school’s leadership was committed to ensuring all students had an understanding about the social and economic factors that lead to health disparities, so all students were required to complete the curriculum.…”

“…One possibility is that integrating only some of the modules may be sufficient, which could be an important finding for medical schools struggling to find the time to implement teaching about the SDH. 11 , 35 For those wishing to implement the full curriculum, the addition of subsequent modules and experiential activities did not add a significant time burden at our medical school per discussions with students and clerkship directors. A second possibility is that when the full curriculum class received the health equity curriculum, the entire medical school was undergoing a curriculum change that resulted in shorter versions of all third-year clerkships to expand time for clinical electives in the fourth year.…”

“…An increasing number of US medical schools have begun to recognize the need for health equity curricula that include issues such as access to care, housing instability, and racial/ethnic bias. 11 National organizations recommend that effective medical school health equity curricula should integrate public health with clinical care, engage with the community, and partner with key community organizations addressing patient needs. 4 Also, these curricula should involve long-term evaluation to determine how they modify students’ behaviors and meet students’ needs.…”

‘Attorneys of the poor’: Training physicians to tackle health inequalities

“…Some call for the undergraduate medical curriculum to remain focused solely on knowledge-based teaching, and that extraneous elements detract from training safe doctors. 54 This presumes that medical school training is a zero-sum game; that a day spent learning about SDH/ HI means a day less training in electrocardiography interpretation or prescribing. Knowledge and skill are not independent and, indeed, additional perspectives aid learning.…”

Assessment Question Characteristics Predict Medical Student Performance in General Pathology

“…In terms of content, educators need to include ever accumulating medical knowledge, modify emphasis and perspective in order to adapt to shifting societal contexts, and attempt to better integrate the dual pillars of basic science and clinical application (as exemplified by learning and practicing evidence-based medicine). [1][2][3][4][5][6] In terms of delivery, there is increasing pressure to emulate the competence-based training models adopted in graduate medical education, a desire to embrace more updated and advanced pedagogic techniques (such as self-directed and team-based learning), and a necessity to incorporate current technologic advances in health care (eg, digital and digitized medicine). [7][8][9] Students use 3 main approaches to learning and studying: deep/thoughtful (seeking to understand, relating new concepts to prior knowledge, and critically examining evidence); superficial/surface (completing the task, memorizing information, and focusing on individual points without recognizing wider context or reflecting on the process); and strategic/efficient (organizing work, managing time, and aiming to efficiently pass any assessment).…”