Flipping social determinants on its head: Medical student perspectives on the flipped classroom and simulated patients to teach social determinants of health

Abstract

Background: Inequalities in healthcare are increasing. Engaging medical students to tackle this urgent challenge alongside clinical sciences can be demanding. This study examines medical student perceptions of a flipped approach to health inequalities co-designed by faculty and sixth-year students.

Innovation: A flipped learning session was piloted for year 4 medical students combining an online lesson followed by a tutorial with a simulated patient.

Methods: A mixed-methods approach collected questionnaire data using 4-point Likert scales and free text answers. A semi-structured group interview was conducted with six voluntary participants.

Results: Two hundred and eighty-nine students completed questionnaires. 85% (n = 246) completed the online lesson. Students agreed the session helped their understanding of key concepts (mean 3.2), was improved by having an actor (mean = 3.6), and was enjoyable (mean = 3.2). Thematic analysis of qualitative questionnaire and interview data revealed three themes: engagement; structure; and attitudes towards social determinants of health. The simulation increased clinical relevance and students gained understanding of the impact of health inequalities upon individuals.

Conclusions: This paper indicates flipped learning can increase clinical relevance and engagement in population health and person-centered care. Further work could assess changes in practice and attitudes of future doctors in tackling such global health challenges.

Acknowledgments

We would like to thank Kristen Swinamer, William Southall and Thomas Ngan for their help in designing the online lesson for this teaching innovation and their insights into how to improve student engagement. We would also like to thank Leonora Weil for her support in delivering tutorials.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

Flipped Classroom: Refers to an approach to teaching where class-time and self-study activities are reversed or “flipped” In practice students prepare for class by pre-reading or watching a prerecorded lecture. Time in class is then used for interactive discussion, problem-solving and other activities (Taken from mededworld.org/glossary).

Public Health: The combination of science, skills, and beliefs that is directed to the improvement of the health of all people through collective, organized efforts of society. Public health goals are: to reduce the amount of disease, premature death and disease-produced discomfort and disability in the population. Public health is thus a social institution, a discipline and a practice (Taken from mededworld.org/glossary).

Social Determinants of Health: The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries (Taken from http://www.who.int/social_determinants/en/).

Additional information

Notes on contributors

N. Gostelow

N. Gostelow, iBSc, MBBS, PGCert, FHEA, is a Clinical Teaching Fellow at University College London Medical School in Clinical and Professional Practice which includes Social Determinants of Health.

J. Barber

J. Barber, MA MB BChiris, a locally funded academic clinical fellow in General Practice at UCL's Department for Primary Care and Population Health and an ST3 GP trainee.

F. Gishen

F. Gishen, BSc, MBBS, FRCP, SFHEA, is a Palliative Care physician and academic lead for Clinical and Professional Practice and lead for Professionalism at University College London Medical School.

A. Berlin

A. Berlin, FRCGP, EdD, is Professor of Primary Care Education and Head of Community Based Medical Education at Barts and the London School of Medicine and Dentistry. Her involvement in this project occurred whilst she was module lead for Social Determinants of Health at University College London Medical School.