Improving Medical Students' Skills to Address Social Determinants of Health during the Internal Medicine Clerkship

Parunyan, Masis; L, Hollander; Hong, Haeyeon; Sylvester, Daniel; Desphande, Janhavee; Eyllon, Mara; Stack, Marna; Quintiliani, Lisa M.; Losi, Stephanie; Vega, Pablo Buitron de la

doi:10.1353/hpu.2020.0154

Cited by 4 publications

(4 citation statements)

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“…Second, physicians who reported feeling a responsibility to address health disparities may have chosen a medical specialty (e.g., family medicine, pediatrics) that is known for engaging vulnerable populations, prioritizing preventive care, and tending to the social risks of their patient populations. 17,18 As discussed below, primary care status was the strongest and most consistent variable associated with physician beliefs and reported actions by physicians on the health care team in our study.…”

Section: Discussionsupporting

confidence: 58%

A Physician’s Sense of Responsibility to Address Disparities: Does It Relate to Reported Behaviors About Screening for and Addressing Social Needs?

Peek¹,

Wang²,

Noriea³

2023

Academic Medicine

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PurposeIt is widely accepted that negative social determinants of health (e.g., poverty) are underlying drivers of poor health and health disparities. There is overwhelming support among physicians to screen for patient-level social needs, but only a minority of clinicians actually do so. The authors explored potential associations between physician beliefs about health disparities and behaviors to screen and address social needs among patients.

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Section: Discussionsupporting

confidence: 58%

A Physician’s Sense of Responsibility to Address Disparities: Does It Relate to Reported Behaviors About Screening for and Addressing Social Needs?

Peek¹,

Wang²,

Noriea³

2023

Academic Medicine

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Section: Assistancementioning

confidence: 99%

“…For example, at Boston Medical Center, educators developed a quality improvement education experience during the internal medicine rotation to equip third-year medical students to use their electronic health record's social risks screening and referral platform. 38 Social workers, community health workers, and other staff may be better suited to connect patients with community services. Nonetheless, medical students should be familiar with how interprofessional teams work to address patients' social needs and with how (and when) to make effective handoffs.…”

Section: Assistancementioning

confidence: 99%

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

2023

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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.

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“…While the preference for verbal data collection has been reported [49,50], other studies in primary care have found patients are more forthcoming when completing self-administered surveys [51,52]. Self-administered electronic surveys are more efficient; they can be integrated into the electronic medical record and provide automated resource referrals [53][54][55]. Our research suggests that a "one-size-fits-all" approach to data collection is unlikely to be appropriate based on the diversity of patient populations [48], alongside considerations for possible trade-offs between the feasibility and acceptability of data collection modalities in inpatient settings.…”

Section: Trust and Patient-centered Carementioning

confidence: 99%

“Addressing the bigger picture”: A qualitative study of internal medicine patients’ perspectives on social needs data collection and use

et al. 2023

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Background There is increasing interest in collecting sociodemographic and social needs data in hospital settings to inform patient care and health equity. However, few studies have examined inpatients’ views on this data collection and what should be done to address social needs. This study describes internal medicine inpatients’ perspectives on the collection and use of sociodemographic and social needs information. Methods A qualitative interpretive description methodology was used. Semi-structured interviews were conducted with 18 patients admitted to a large academic hospital in Toronto, Canada. Participants were recruited using maximum variation sampling for diverse genders, races, and those with and without social needs. Interviews were coded using a predominantly inductive approach and a thematic analysis was conducted. Results Patients expressed that sociodemographic and social needs data collection is important to offer actionable solutions to address their needs. Patients described a gap between their ideal care which would attend to social needs, versus the reality that hospital-based teams are faced with competing priorities and pressures that make it unfeasible to provide such care. They also believed that this data collection could facilitate more holistic, integrated care. Patients conveyed a need to have a trusting and transparent relationship with their provider to alleviate concerns surrounding bias, discrimination, and confidentiality. Lastly, they indicated that sociodemographic and social needs data could be useful to inform care, support research to inspire social change, and assist them with navigating community resources or creating in-hospital programs to address unmet social needs. Conclusions While the collection of sociodemographic and social needs information in hospital settings is generally acceptable, there were varied views on whether hospital staff should intervene, as their priority is medical care. The results can inform the implementation of social data collection and interventions in hospital settings.

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Improving Medical Students' Skills to Address Social Determinants of Health during the Internal Medicine Clerkship

Cited by 4 publications

References 0 publications

A Physician’s Sense of Responsibility to Address Disparities: Does It Relate to Reported Behaviors About Screening for and Addressing Social Needs?

A Physician’s Sense of Responsibility to Address Disparities: Does It Relate to Reported Behaviors About Screening for and Addressing Social Needs?

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

“Addressing the bigger picture”: A qualitative study of internal medicine patients’ perspectives on social needs data collection and use

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