Neighbourhood walking tours for physicians-in-training

Abstract

Social and economic factors have a profound impact on patient health. However, education about these factors has been inconsistently incorporated into residency training. Neighbourhood walking tours may help physician-residents learn about the social determinants of health (SDoH). We assessed the impact of a neighbourhood walking tour on physician-residents’ perceptions of SDoH, plans for counselling patients and knowledge of community resources. Using a community-based participatory research approach, in 2017 we implemented a neighbourhood walking tour curriculum for physician-residents in internal medicine, internal medicine/primary care, emergency medicine, paediatrics, combined internal medicine/paediatrics and obstetrics/gynaecology. In both pre-tour and post-tour, we asked participants to (1) rank the importance of individual-level and neighbourhood-level factors affecting patients’ health, (2) describe strategies used to improve health behaviours and (3) describe knowledge of community resources. Eighty-one physician-residents participated in walks (pre-tour surveys (93% participation rate (n=75)), and post-tour surveys (53% participation rate (n=43)). Pre-tour, the factor ranked most frequently affecting patient health was ‘access to primary care’ (67%) compared with post-tour: ‘income’ (44%) and ‘transportation’ (44%). In describing ways to improve diet and exercise, among pre-tour survey respondents, 67% discussed individual-level strategies and 16% discussed neighbourhood-level, while among post-tour survey respondents, 39% of respondents discussed individual-level strategies and 37% discussed neighbourhood-level. Percentage of respondents aware of community resources changed from 5% to 76% (p<0.001). Walking tours helped physician-residents recognise the importance of SDoH and the value of community resources, and may have broadened frameworks for counselling patients on healthy lifestyles.

Using Critical Pedagogy to Advance Antiracism in Health Professions Education

“…Neighborhood walking tours and street art tours for resident physicians that were developed and facilitated by community leaders have been shown to improve resident physicians' understanding of neighborhood-level social and structural determinants of health. 70 Another community co-designed experiential learning initiative for emergency medicine residents led to long-term improvements in their self-reported ability to apply trauma-informed de-escalation approaches to agitated patients. 71 Finally, a collection of educational experiences based on Augusto Boal's Theatre of the Oppressed, 72 Freire's critical pedagogy, and sensible cognition-the notion that one's understanding of the world is based in one's senses and influenced by one's emotions-aimed to improve trainees' personal and professional development, understanding of medical training's hidden curriculum, and emotional processing and reconciliation of challenging clinical situations.…”

“…66 Extra-clinical experiences like these can ensure that health professions trainees build critical consciousness of and structural empathy for the hyperlocal contexts and lived experiences of their patients and colleagues, 33,35 although evaluation of the efficacy of these novel curricular interventions has often been limited to learner self-reported data. 70,71 Podcasts can also motivate antiracist action. 73,74,75,76,77 The Clinical Problem Solvers' Antiracism in Medicine Series was created by a multidisciplinary, trainee-predominant team at the start of the COVID-19 pandemic and in the aftermath of George Floyd's murder to redress a lack of action-oriented antiracism education in medical training.…”