Abstract:

Social determinants of health (SDH) have a significant impact on health outcomes. Physicians can improve health outcomes for their patients by addressing these issues in clinical practice. With increased recognition of the critical role played by the SDH in individual-level and population health, medical schools have begun to incorporate these topics in their curricula. Furthermore, accrediting bodies and national medical organizations increasingly recognize the importance of integrating public and population health concepts in medical education. However, few models exist for designing specific courses and experiences that address these topics. To address this gap in medical education, we developed and assessed a curriculum exploring the key concepts within health disparities and SDH and modified it for distance learning.

Methods:
The curriculum was conceived for medical students that have finished at least 6 months of clinical rotations and was disseminated as half-day large-group sessions hosted by a diverse faculty of clinical experts, community educators, public health advocates, and leaders of local organizations over 16 weeks in the spring (2018-2020). The curriculum included training on Implicit Bias, Intimate Partner Violence, Human Trafficking, and covered disparities and Racism, Incarceration, LGBTQ+, Refugee and Immigrant health among others. The content was taught with modules, panel discussions, small and large group lectures, and additionally used flip classroom and research presentations. We employed both Formative evaluations to assess educational outcomes at the end of each session as well as Summative evaluations as a one-time, end-of-course tool to assess the overall value, framework of the course, and its structural and procedural aspects.

Results:
The overall objective of increasing awareness of SDH in medical students was studied. The average scores on the Summative evaluations of the years 2018 and 2019 from 150 students each year reported an average score of 5.33 and 5.56 respectively on the scale of 1-7 (an institutional standard). The aggregate formative assessment of this particular objective in the sessions for the same cohort of students was 5.95 and 5.60 respectively in the two years identified above. For the 2020 course (distance learning), 200 students of the new class reported average scores of 6.41 on the same scale for the Summative and 6.73 on the formative assessment.

Conclusion:
This study aimed to assess the impact of our SDH course on increasing awareness of medical students. This objective was rated higher when the assessment was administered after each session rather than at the end of the course. The trend was noted across all three years despite variation in the subjects each year. The curriculum and the faculty staying constant, the course evaluations, both Summative and formative were rated higher when delivered virtually. The reason for this is unclear and needs to be studied further. However, it was determined that SDH content is recognized by medical students as an important addition to medical education and educators will be required to create novel methods and tools for its delivery and assessment including the use of hybrid templates employing elements of distance learning.

Keywords:

Social Determinants of Health, Medical Education, Curriculum, Assessment.