Awareness, Adjustment, Assistance, Alignment, and Advocacy: Operationalizing Social Determinants of Health Topics in Undergraduate Medical Education Curricula

Abstract

Social and economic factors, such as those related to food, housing, and transportation, are major drivers of health and health inequities. Multiple national professional organizations have articulated roles for physicians in identifying and addressing social determinants of health (SDOH) and the need to include SDOH in all stages of physician education. Despite encouragement from these professional organizations, medical schools still do not routinely offer SDOH education alongside basic and clinical sciences curricula. A recent national expert consensus process identified priority SDOH knowledge domains and professional skills for medical students but lacked an organizing schema and specific pedagogical examples to help translate prioritized skills into routine pedagogical practice. One such schema is the 5As framework developed by the National Academies of Sciences, Engineering, and Medicine, which elaborates on 5 strategies to strengthen social care: awareness, adjustment, assistance, alignment, and advocacy. In this article, the authors highlight and provide examples of how mapping SDOH skills to the 5As framework can help educators meaningfully operationalize SDOH topics into specific curricular activities during the preclinical and clinical stages of undergraduate medical education. As a foundational first step in this direction, medical schools should conduct an internal curricular review of social care content (ideally mapped to the 5As framework) and identify opportunities to integrate these topics into existing courses when relevant (e.g., in social medicine, population health, and health systems science courses). Given that health and social care integration is highly context dependent, each medical school will likely need to tailor curricular changes based on their own institutional needs, mission, patient populations, and ties to the community. To increase interinstitutional alignment, medical schools might consider using or adapting peer-reviewed materials and assessments curated and centralized by the National Collaborative for Education to Address the Social Determinants of Health.

Survey of attitudes toward performing and reflecting on required team service-learning (SASL): psychometric data and reliability/validity for healthcare professions students in preclinical courses

“…Such training efforts have potential to be applied in other healthcare professions ( 39 , 41 ). These curricula would foster the health of those people against whom there are unconscious biases and, thus, promote public health ( 42 ).…”

Triple Approach to Program Evaluation and “Contextual Program Evaluation Model” Proposal

“…In this context, medical education programs and healthcare processes focus on community health-related conditions (social determinants of health, vulnerable, underserved populations and health, health equity) and contextualized social care (Sandhu et al, 2023). In recent years, new ones have been added in the context of social relevance, social responsiveness, social responsibility, and social accountability in relation to community health needs and health priorities (Boelen et al, 2016;Rourke, 2018).…”