Social Contexts in Medicine: A Patient-Centered Curriculum Empowering Medical Students to Provide Contextualized Care

Abstract

Introduction: Social Contexts in Medicine (SCIM) is an 18-month program that connects medical students, patients, and physicians for a longitudinal learning experience. SCIM was developed for first-and secondyear medical students and seeks to supplement students' biomedical education with practical experiences built around community and continuity. The program increases students' awareness of, and skills to address, social determinants of health via a seminar series, a home visit program, and a mentoring component. Methods: The program begins with a seminar series covering communication skills and the basics of social determinants of health, providing the foundation for successful home visits. Students are then paired with a patient for home visits to learn firsthand about the complex social factors that affect health and illness, patient participation in health care systems, and the doctor-patient relationship. In conjunction with the home visits, students obtain guidance from a physician mentor. Results: The SCIM program has been successful during its first 3 years at our institution. Analysis of changes in student attitudes using Crandall's Medical Student Attitudes Toward the Underserved survey has shown that SCIM students develop more positive attitudes toward the underserved than do their peers completing traditional clinic-based preceptorships. Additionally, in student surveys, the average response to the statement "I learned something valuable I would not have otherwise learned in my classes" has been 4.5 out of 5. Discussion: These findings suggest that the SCIM model contributes to medical education by broadening students' understanding about the influence of social factors on health and disease.

Social Determinants of Health Curriculum Integrated Into a Core Emergency Medicine Clerkship

“…A simple evaluation tool (Appendix E) was developed at the outset of this project by faculty consensus. Given the wide range of postcurriculum evaluations used by other groups for similar curricula 12,13 and the difficulty finding a validated instrument, we attempted to capture the tasks we hoped an introductory curriculum would accomplish—a capacity to recognize SDH, screen for them, use that knowledge to refer patients to resources, and comprehend the importance of SDH to overall health. Our questionnaire, which is in the process of being validated but had not been at the time of its use for this module, was included in the end-of-course evaluation filled out by students.…”

Effectiveness of alternative approaches to integrating the Social Determinants of Health into medical education: a systematic review

“…Six medical schools included the SDOH curricula as a mandatory module (16-20,23) , whereas two had it as an elective course (21,22). The included programs varied in duration and timing during medical school training.…”

Critical Consciousness as a Framework for Health Equity–Focused Peer Learning

“…Critical consciousness is a topic with limited discussion to date in MedEdPORTAL, with existing publications focusing on the application of critical consciousness to onetime educational activities related to faculty development on multicultural education, 5 community empowerment, 6 and responding to racism, discrimination, and microaggressions. 7 The educational content described here overlaps with that of other publications in MedEdPORTAL, including discussions of identity, 8-10 privilege, 8 microaggressions, 7,11,12 racism, 13,14 health disparities, 15,16 the social determinants of health, 15,17,18 and implicit bias. 19,20 However, CCM is unique in that it adopts critical consciousness as the unifying concept and approach for a series of studentled workshops spanning these topics for all first-year medical students at our institution.…”