Introducing the Concepts of Advocacy and Social Determinants of Health Within the Pediatric Clerkship

Abstract

IntroductionAlthough advocacy and social determinants of health (SDH) are fundamental components of pediatrics and other areas of health care, medical education often lacks formal training about these topics and the role of health care professionals as advocates. SDH are common targets of advocacy initiatives; however, little is known about optimal ways to incorporate this content into medical education curricula.MethodsWe developed a lecture and assessment for third-year medical students that included interactive discussion of advocacy, SDH issues specific to children, and opportunities for learners to engage in advocacy. Learners attended the lecture during the pediatric clerkship. Over the course of a year, questionnaires assessing knowledge of advocacy, SDH, and incorporation of advocacy into practice were administered to 75 students before the lecture and as the clerkship ended. We used chi-square and Fisher's exact tests to compare knowledge before and after the lecture.ResultsStudents showed significant improvement on most individual questions and overall passing rates. Learners provided positive feedback on the quality of the lecture material and demonstrated interest in engaging in current advocacy projects to address SDH.DiscussionAs recognition of the importance of advocacy and SDH increases, the development of educational tools for teaching this information is critical. Our lecture produced significant improvement in knowledge of these topics and was well received by students. Early introduction to advocacy and SDH during relevant clinical rotations emphasizes the importance of these topics and may establish a foundation of advocacy as fundamental to health care.

Using simulation to increase resident comfort discussing social determinants of health

“…This adds to existing evidence in undergraduate and graduate medical education that SDoH education increases the frequency of addressing SDoH in a clinical context. Upon completion of a lecture-based SDoH curriculum, pediatric clerkship students improved their overall knowledge regarding SDoH and also reported increased frequency in discussions of food insecurity with patients [ 8 ]. Although it is unknown whether these habits continued during residency, this nonetheless highlights the importance of studying the long-term impact of SDoH curricular interventions.…”

“…Historically, pediatric trainees have inadequate training to identify and intervene on the unmet needs associated with SDoH [ 6 ]. Recent educational interventions focused on improving the knowledge of and attitudes towards addressing SDoH in a clinical setting have shown promising results [ 7 , 8 ]. Didactic- and immersion-based efforts to provide training to pediatric residents on SDoH have resulted in improved trainee knowledge and comfort with discussing social determinants of health [ 9 ].…”

Developing and implementing core competencies in children’s environmental health for students, trainees and healthcare providers: a narrative review

“…Some examples include a discussion of environmental triggers and air pollution’s impact on lung development in pulmonology sessions on asthma, discussion of endocrine disrupting chemicals in relevant endocrinology course, and discussion of climate change-related expanding range of vector-borne diseases in infectious disease courses. Clinical clerkships and residency training: Medical schools and residencies have begun to incorporate social determinants of health and advocacy training in clerkships and residencies across specialties [ 63 – 65 ]. EH (including environmental justice) is an important component to include among the social determinants and can be a focus for advocacy training and case studies.…”

“…Clinical clerkships and residency training: Medical schools and residencies have begun to incorporate social determinants of health and advocacy training in clerkships and residencies across specialties [ 63 – 65 ]. EH (including environmental justice) is an important component to include among the social determinants and can be a focus for advocacy training and case studies.…”

Down to the Last Dollar: Utilizing a Virtual Budgeting Exercise to Recognize Implicit Bias

“…For third-year pediatric clerkship students, Dr. Melanie C. Marsh and colleagues published a didactic curriculum utilizing an interactive discussion of advocacy and SDOH specific to children. 6 The Community Pediatrics Training Initiative of the American Academy of Pediatrics published a project planning tool in MedEdPORTAL, which focuses on pediatric residency trainees as an individual or group exercise with guided reflection. 7 Furthermore, residency programs and medical schools have implemented the Missouri Community Action Network poverty simulation kit; the kits cost $2,300.…”