Teaching the Social Determinants of Health in Undergraduate Medical Education: a Scoping Review

Abstract

BACKGROUND: To provide optimal care, medical students should understand that the social determinants of health (SDH) impact their patients' well-being. Those charged with teaching SDH to future physicians, however, face a paucity of curricular guidance. OBJECTIVE: This review's objective is to map key characteristics from publications about teaching SDH to students in undergraduate medical education (UME). METHODS: In 2016, the authors searched PubMed, Embase, Web of Science, the Cochrane and ERIC databases, bibliographies, and MedEdPORTAL for articles published between January 2010 and November 2016. Four reviewers screened articles for eligibility then extracted and analyzed data descriptively. Scoping review methodology was used to map key concepts and curricular logistics as well as educator and student characteristics. RESULTS: The authors screened 3571 unique articles of which 22 were included in the final review. Many articles focused on community engagement (15). Experiential learning was a common instructional strategy (17) and typically took the form of community or clinic-based learning. Nearly half (10) of the manuscripts described school-wide curricula, of which only three spanned a full year. The majority of assessment was self-reported (20) and often related to affective change. Few studies objectively assessed learner outcomes (2). CONCLUSIONS: The abundance of initial articles screened highlights the growing interest in SDH in medical education. The small number of selected articles with sufficient detail for abstraction demonstrates limited SDH curricular dissemination. A lack of accepted tools or practices that limit development of robust learner or program evaluation was noted. Future research should focus on identifying and evaluating effective instructional and assessment methodologies to address this gap, exploring additional innovative teaching frameworks, and examining the specific contexts and characteristics of marginalized and underserved populations and their coverage in medical education.

Scottish Medical Student Experience of Learning About Social Determinants of Health

“…We thank Doobay-Persaud et al 1 for their review of Social Determinants of Health (SDH) teaching in Undergraduate Medical Education in North America. We believe this to be a crucial element of good medical practice and agree it is essential to introduce at the undergraduate level.…”

Cascading Mentorship as Advocacy Training in Undergraduate Medical Education: A Mixed Methods Evaluation

“…Experiential learning and community engagement in health advocacy training has been implemented in various undergraduate medical education programs [8]. Several medical schools, including the University of Toronto (UofT), have integrated community-based service learning (CBSL) as a tool for medical trainees to engage in experiential learning opportunities while also addressing community needs [9].…”

Evolution of a community-centred experiential learning module: A mixed-methods approach to promote social accountability and community partnership in undergraduate medical education

“…Since it is difficult to teach social aspects of medicine in traditional classroom settings (Meili, Fuller, and Lydiate, 2011), medical education is often complemented by experiential learning in the communities, requiring partnership between Colleges and communities. One important form of this learning is Community-Based Education (CBE;Doobay-Persaud et al, 2019). CBE that involves learning activities carried out in community settings is becoming an essential component in medical curricula (Magzoub and Schmidt, 2000), and can take different forms at pre-clerkship level: service project, community-based participatory research, and/or neighbourhood visits (Choulagai, 2019;Doobay-Persaud et al, 2019).…”

“…One important form of this learning is Community-Based Education (CBE;Doobay-Persaud et al, 2019). CBE that involves learning activities carried out in community settings is becoming an essential component in medical curricula (Magzoub and Schmidt, 2000), and can take different forms at pre-clerkship level: service project, community-based participatory research, and/or neighbourhood visits (Choulagai, 2019;Doobay-Persaud et al, 2019). CBE can include short-term initiatives, whether as singular program (Duffy et al, 2014) or course component (Asgary et al, 2016).…”