Using simulation to increase resident comfort discussing social determinants of health

Abstract

Background Social determinants of health (SDoH) play an important role in pediatric health outcomes. Trainees receive little to no training on how to identify, discuss and counsel families in a clinical setting. The aim of this study was to determine if a simulation-based SDoH training activity would improve pediatric resident comfort with these skills. Methods We performed a prospective study of a curricular intervention involving simulation cases utilizing standardized patients focused on four social determinants (food insecurity, housing insecurity, barriers to accessing care, and adverse childhood experiences [ACEs]). Residents reported confidence levels with discussing each SDoH and satisfaction with the activity in a retrospective pre-post survey with five-point Likert style questions. Select residents were surveyed again 9–12 months after participation. Results 85% (33/39) of residents expressed satisfaction with the simulation activity. More residents expressed comfort discussing each SDoH after the activity (Δ% 38–47%; all p < .05), with the greatest effect noted in post-graduate-year-1 (PGY-1) participants. Improvements in comfort were sustained longitudinally during the academic year. More PGY-1 participants reported engaging in ≥ 2 conversations in a clinical setting related to food insecurity (43% vs. 5%; p = .04) and ACEs (71% vs. 20%; p = .02). Discussion Simulation led to an increased resident comfort with discussing SDoH in a clinical setting. The greatest benefit from such a curriculum is likely realized early in training. Future efforts should investigate if exposure to the simulations and increased comfort level with each topic correlate with increased likelihood to engage in these conversations in the clinical setting.

Harm reduction in undergraduate and graduate medical education: a systematic scoping review

“…Of the 19 distinct curricula reviewed, didactics and small group discussion comprised most of the instruction with 4 programs employing standardized simulated clinical encounters/scenarios (e.g., OSCEs, SPs, mannequins). As with other topics that are similarly stigmatized or difficult to operationalize (e.g., serious illness, social determinants of health, LGBTQ health), we suggest that programs prioritize demonstrating these conversations and creating opportunities for trainees to practice them [ 115 – 117 ]. Programs could create a list of harm reduction-based clinical probes and demonstrate when/how to use them as well as utilizing publicly available resources, such as NIDA’s Words Matter project and Dr. Kimberly L. Sue’s clinical case study on The Curbsiders Addiction Medicine podcast [ 11 , 118 ].…”

Simulation for diversity, equity and inclusion in emergency medicine residency training: A qualitative study

“…While there were many curricula identified in other specialties, within undergraduate medical education, and other disciplines such as nursing, most topics were limited to one specific aspect of DEI such as caring for transgender or gender‐nonconforming patients or caring for patients with limited English proficiency (Appendix S1). 13–26 …”