Addressing the Social Determinants of Health in Undergraduate Medical Education Curricula: A Survey Report

Joy H Lewis; Onelia G Lage; B Kay Grant; Senthil K Rajasekaran; Mekbib Gemeda; Robert C Like; Sally Santen; Michael Dekhtyar

doi:10.2147/AMEP.S243827

Addressing the Social Determinants of Health in Undergraduate Medical Education Curricula: A Survey Report

Adv Med Educ Pract. 2020 May 22:11:369-377. doi: 10.2147/AMEP.S243827. eCollection 2020.

Authors

Joy H Lewis¹, Onelia G Lage², B Kay Grant³, Senthil K Rajasekaran⁴, Mekbib Gemeda⁵, Robert C Like⁶, Sally Santen⁷, Michael Dekhtyar⁸

Affiliations

¹ School of Osteopathic Medicine in Arizona, A.T. Still University of Health Sciences, Mesa, AZ, USA.
² Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
³ Office of Health Professions Education, Nebraska Medicine, Omaha, NE, USA.
⁴ Academic Affairs, Eastern Virginia Medical School, Norfolk, VA, USA.
⁵ Diversity and Inclusion, Eastern Virginia Medical School, Norfolk, VA, USA.
⁶ Department of Family Medicine and Community Health, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
⁷ Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA.
⁸ Medical Education Outcomes, American Medical Association, Chicago, IL, USA.

Abstract

Purpose: Social determinants of health (SDH) are recognized as important factors that affect health and well-being. Medical schools are encouraged to incorporate the teaching of SDH. This study investigated the level of commitment to teaching SDH; learning objectives/goals regarding student knowledge, skills, and attitudes; location in the curriculum and teaching strategies; and perceived barriers to teaching SDH.

Methods: A team from the American Medical Association's Accelerating Change in Medical Education Consortium developed a 23-item inventory survey to document consortium school SDH curricula. The 32 consortium schools were invited to participate.

Results: Twenty-nine (94%) schools responded. Most respondents indicated the teaching of SDH was low priority (10, 34%) or high priority (12, 41%). Identified learning objectives/goals for student knowledge, skills, and attitudes regarding SDH were related to the importance of students developing the ability to identify and address SDH and recognizing SDH as being within the scope of physician practice. Curricular timing and teaching strategies suggested more SDH education opportunities were offered in the first and second undergraduate medical education years. Barriers to integrating SDH in curricula were identified: addressing SDH is outside the realm of physician responsibility, space in curriculum is limited, faculty lack knowledge and skills to teach material, and concepts are not adequately represented on certifying examinations.

Conclusion: Despite the influence of SDH on individual and population health, programs do not routinely prioritize SDH education on par with basic or clinical sciences. The multitude of learning objectives and goals related to SDH can be achieved by increasing the priority level of SDH and employing better teaching strategies in all years. The discordance between stated objectives/goals and perceived barriers, as well as identification of the variety of strategies utilized to teach SDH during traditional "preclinical" years, indicates curricular areas in need of attention.

Keywords: barriers to teaching; health system science; social factors; teaching strategies.