Expert Consensus Guidelines for Assessing Students on the Social Determinants of Health

Abstract

Phenomenon

Assessment and evaluation guidelines inform programmatic changes necessary for educational effectiveness. Presently, no widely accepted guidelines exist for educators to assess learners and evaluate programs regarding social determinants of health (SDOH) during physician and physician assistant (PA) education. We sought to garner expert consensus about effective SDOH learner assessment and program evaluation, so as to make recommendations for best practices related to SDOH education.

Approach

We used a Delphi approach to conduct our study (September 2019 to December 2020). To administer our Delphi survey, we followed a three-step process: 1) literature review, 2) focus groups and semi-structured interviews, 3) question development and refinement. The final survey contained 72 items that addressed SDOH content areas, assessment methods, assessors, assessment integration, and program evaluation. Survey participants included 14 SDOH experts at US medical schools and PA programs. The survey was circulated for three rounds seeking consensus, and when respondents reached consensus on a particular question, that question was removed from subsequent rounds.

Findings

The geographically diverse sample of experts reached consensus on many aspects of SDOH assessment and evaluation. The experts selected three important areas to assess learners’ knowledge, skills, and attitudes about SDOH. They identified assessment methods that were “essential”, “useful, but not essential”, and “not necessary.” The essential assessment methods are performance rating scales for knowledge and attitudes and skill-based assessments. They favored faculty and patients as assessors, as well as learner self-assessment, over assessments conducted by other health professionals. Questions about separation versus incorporation of SDOH assessment with other educational assessment did not yield consensus opinion. The experts reached consensus on priority outcome measures to evaluate a school’s SDOH program which included student attitudes toward SDOH, Competence-Based Assessment Scales, and the percentage of graduates involved in health equity initiatives.

Insights

Based on the Delphi survey results, we make five recommendations that medical and PA educators can apply now when designing learner assessments and evaluating SDOH programming. These recommendations include what should be assessed, using what methods, who should do the assessments, and how they should be incorporated into the curriculum. This expert consensus should guide future development of an assessment and evaluation toolkit to optimize SDOH education and clinical practice.

Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2022.2045490 .

Keywords:

• Social determinants of health
• assessment
• program evaluation

Acknowledgments

The authors wish to thank all the expert Delphi panelists for their time and thoughtful responses.

Declaration of interest

This project is supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services under Grant ID# HRSA-16-041. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

1. Patient-centered outcomes/quality of care

2. Institutional culture around SDOH

3. Learner behavior

4. Learner knowledge

5. Faculty attitudes toward SDOH

6. Population health measures

7. Learner reaction/satisfaction

8. Interprofessional teamwork

9. Learner career choice

10. Faculty satisfaction with the teaching experience

    Least effective