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

Abstract

Background There is increasing recognition to include social determinants of health (SDOH) teaching for future doctors. However, the educational methods and the extent of integration into the curriculum vary considerably - this scoping review is aimed at how SDOH has been introduced into medical schools' curricula. Methods A systematic search was performed of six electronic databases, including PubMed, EBSCO, Scopus, OVID (Medline), APA Psych Info, and ERIC. The initial search yielded 654 articles after removing duplicates. Articles were excluded if they did not cover the SDOH curriculum for medical students; were based on service-learning rather than didactic content; were pilot courses, or were not in English, leaving eight articles in the final study. Results There was considerable heterogeneity in the content, structure and duration of SDOH curricula. Of the eight included studies, six were in the United States(U.S.), one in the United Kingdom (U.K.) and one in Israel. Four main conceptual frameworks were invoked: the U.S. Healthy People 2020, two World Health Organisation frameworks (The Life Course and the Michael Marmot's Social Determinants of Health), and the National Academic of Science, Engineering, and Medicine's (Framework For educating Health Professionals to Address the Social Determinants of Health). In general, programs that lasted longer appeared to perform better than shorter duration programs. Students favoured interactive, experiential-learning teaching methods over the traditional classroom-based teaching methods. Conclusion The incorporation of well-structured SDOH curricula capturing both local specification and a global framework when combined with a combination of traditional and interactive teaching methods over more extended periods may be helpful to steps for creating lifelong learners and socially accountable medical school education.