Representation of social determinants of health in German medical education: protocol of a content analysis study

Abstract

IntroductionAction on the social determinants of health has been key for improving health and prolonging life in the past, and remains so today. Against this background, WHO’s Commission on Social Determinants of Health has called for increased efforts to create health workforces trained in recognising, understanding and acting on the social determinants of health. However, little is known about the extent to which current medical education systems prepare graduates for this challenge. We, therefore, aim to analyse the extent to which the medical curriculum in Germany incorporates content on the social determinants of health.Methods and analysisWe will conduct a qualitative and quantitative content analysis of four key document groups which influence medical education in Germany: the national medical catalogue of learning objectives; examination content outlines provided by the German Institute for Medical and Pharmaceutical Examination Questions; the online textbook most widely used for final examination preparation and the full set of questions from two national medical licensing examinations. We will analyse these documents based on a coding system, which we derived deductively from the report of WHO’s Commission on Social Determinants of Health as well as other key publications of WHO. We will report quantitative indicators, such as the percentage of text related to social determinants of health for each document type. Moreover, we will conduct a semiqualitative analysis of relevant content.Ethics and disseminationThis study is based on the analysis of existing documents which do not contain personal or otherwise sensitive information. Results from the study will be published in a scientific peer-reviewed journal.

How are social determinants of health represented in German medical education?: a qualitative content analysis of key-curricular documents

“…These documents are provided in our study protocol. 21 The coding framework consists of 12 codes (figure 1) plus two auxiliary codes: (1) Socioeconomic status and health, to be applied to passages with reference to the interaction between socioeconomic status and health (eg, by discussing the interaction between poverty and health outcomes) and (2) explicit, to be applied to passages making an explicit reference to SDH-relevant aspects, (eg, by discussing the impact of a family environment affecting a child's access to medical services) instead of merely mentioning SDH (eg, by mentioning different social environments).…”

“…The methods of our analysis are outlined in detail in our study protocol. 21 Patient and public involvement Patients and the public were not involved in the design or conduct of the study.…”

“…21 A summary of the study results focused on the NKLM contributed to the current debate on the NKLM revision process in Germany. 22…”

“…Our analysis is based on a predeveloped and peer-reviewed study protocol. 21 The methodology to assess the way and extent to which a topic is covered in the German medical education could be adapted to other related questions and document groups (eg, to assess the individual curricula of all medical schools in Germany). The results provide valuable insights into the current role of SDH in the medical curriculum in Germany.…”

Soziale Determinanten von Gesundheit als Lehr- und Prüfungsinhalte im Medizinstudium

“…Mittels eines Kodiersystems, entwickelt auf Basis einschlägiger WHO-Dokumente, wurde eine quantitative und qualitative Inhaltsanalyse durchgeführt. Die Entwicklung des Kodiersystems sowie eines Leitfadens zur Kodierung ist im entsprechenden Studienprotokoll detailliert aufgeführt [14]. Das Kodiersystem besteht aus 12 Codes (▶ Tab.…”