Context matters: Integration of social determinants of health in AEGD and GPR curricula

Abstract

Purpose To examine the integration of social determinants of health (SDH) in the US Advanced Education in General Dentistry (AEGD) and General Practice Residency (GPR) programs. Methods This study used an explanatory sequential mixed‐methods approach. A 46‐question survey was sent to all 265 AEGD and GPR programs in February 2019. Descriptive statistics and multivariate analyses were conducted to identify factors influencing SDH curricular inclusion. A convenience sample of program directors (PDs) was interviewed between June and December 2019. Through content analysis, themes and subthemes were identified. Results Of the 265 AEGD and GPR PDs, 111 completed the survey (42% response rate). Almost three‐quarters of PDs (72%) agreed that it was important for residents to understand basic SDH concepts. However, programs lacked eight of the 10 surveyed SDH subtopics. The odds of teaching five or more SDH subtopics were 0.09 (95% CI: 0.02–0.41) for programs with none‐to‐minimal levels of SDH integration in their clinical settings compared to close‐to‐fully integrated ones. Coding of PD interviews (N = 13) identified five major themes: 1. influences to integrate SDH, 2. training strategies, outcomes, and outputs, 3. reasons for training strategies, 4. barriers and solutions, and 5. future integration goals. Most PDs cited delivering SDH content during patient care and reported time and organizational culture being barriers to more curricular inclusion. Conclusions AEGD and GPR curricula are deficient in SDH content and risk underpreparing residents for caring for the underserved. PDs and organizational leaders must prioritize SDH inclusion in order to train dentists for integrated person‐centered care.

Trends in Scope of Practice for Oral Health Care: Future Transformative Effects

“…Primary care in medicine has led the way in incorporating social determinants of health screening and addressing its importance in patient care through connecting patients to supportive services. Oral health primary care has also begun to make progress (LaForge et al 2018; Jiang et al 2021). Our profession must incorporate a broader understanding of health determinants and the interplay of chronic health conditions.…”

Evaluation of the Oral Health Knowledge Network’s Impact on Pediatric Clinicians and Patient Care

“…From 21 survey respondents willing to be interviewed, we selected a purposive mixed sample of 11 respondents (nonclinicians, nonmedical clinicians, and medical clinicians) for interviews. A semistructured interview guide was developed from previous research 13,14 with minor modifications based on the 3 cohorts of interviewees (Supplemental Appendix 1, Supplemental Appendix 2, and Supplemental Appendix 3). The interview guides covered topics that included an overview of the participant's professional role; involvement with and impact and evaluation of the OHKN; factors influencing MDI; barriers to integration activities; and suggestions for future OHKN sessions.…”

“…We developed a coding framework using the interview guides, discussions among the team members, and previous research. 13 Once the 2 authors (T.J. and C.A.R.) reached consensus, parent codes and subthemes were collated and summarized.…”