An Adapted Framework for Incorporating the Social Determinants of Health into Predoctoral Dental Curricula

Abstract

Social determinants of health (SDH) impact the overall health and well‐being of the entire population. It is imperative to train future health care professionals to develop an understanding of the impact of these determinants, so they can provide contextual treatment more conscious of the culturally, racially, and socioeconomically diverse populations they will care for during their careers. This article, the second in a series of American Dental Education Association Commission on Change and Innovation in Dental Education 2.0 white papers on SDH, introduces a conceptual framework adapted from the original framework presented by the National Academies of Science, Engineering, and Medicine that can be applied to predoctoral dental curricula. This framework is organized into three domains: education, organization, and community. The domains are explained, and examples of current implementation efforts at several academic dental institutions are provided to help dental educators envision how to incorporate these concepts into their own curricula.

How are the social determinants of health being taught in dental education?

“…When asked about the relative importance of different elements of the dental curriculum, educators ranked clinical and technical competencies above the development of social responsibility and ethics when considering the importance of different curriculum elements 45 . This demonstrates the need for holistic and systematic integration of SDH into the curriculum as described by Tiwari et al., who suggested 3 domains of action: education; organization, and; community, which create a culture based on embedded values relating to SDH 46 . The importance of curricula in challenging negative stereotypes and judgments about those receiving welfare was highlighted by Lévesque et al 47 .…”

“…Recent interest in humanities teaching in dental education, 51 the identification of social and community orientation as a domain required for dental graduates to be prepared for practice 52 and publication of an adapted framework for incorporating SDH into dental education 46 are important signals. These papers signify continued awareness of the need for dental students to understand and take purposeful action about the social as integral to the mission of clinical practice, rather than an incidental subject that is separated from clinical practice.…”

“…Yet, still in 2020, Johnsen notes, “What ‘counts’ for final determination of entry level competency in schools is overwhelmingly knowledge and technical.” 53 There are several reasons for the discrepancy between what is recognized as important and actual curricula. For instance, it has been proposed that the lack of a body of established scholarship and prototypes for curriculum design and assessment, as well as the inherent organizational difficulties in arranging a program of learning that does not neatly fit into established clinical and basic science discipline and department structures are barriers to the implementation 46,53 …”

Students' Evaluations of Simulations in Dentistry: A Multiple Cohort Study at a U.S. Dental School

“…Dental education related to social determinants of health (SDH) may include classroom instruction, service‐learning activities, and community rotations 25 . Simulation may effectively supplement such experiences in the SDH domain, as it provides a controlled environment that allows for inclusion of selected patient characteristics as well as targeted practice of specific communication skills.…”

“…However, poverty simulations may not explicitly link SDH to dental patient care. Although universally incorporating SDH instruction throughout the curriculum has been recommended, 25 high‐intensity, SDH‐focused experiences such as simulation may anchor such efforts and result in a greater likelihood to treat vulnerable populations after graduation 27 …”