A patient-centered approach to learning social determinants of health for first year medical students

Abstract

Introduction

To address health disparities, future physicians must understand the role of social determinants of health (SDH). Teaching SDH can be challenging. We created an authentic SDH curriculum using four real myocardial infarction (MI) patients.

Methods

During the three academic years from 2019–2020 to 2021–2022, 579 first year medical students participated in the four day curriculum. Day 1: students interviewed and learned about their patient’s MI. Day 2: students met in small groups and shared their patient’s history. At session end, students were familiar with four patient stories. Day 3: students explored their patient’s neighborhood and then interviewed their patient again, focusing on SDH. Day 4: students gave formal patient presentations that highlighted SDH. Group discussion followed and reinforced the role of SDH. Students wrote reflections on SDH that were read and graded. End of course evaluations were reviewed.

Results

Five hundred and seventy-nine students completed the curriculum. Course directors graded SDH reflections on a six-point rubric for the years of 2020–2021 and 2021–2022. Ninety percent and 96% of the SDH reflections during the respective years contained 5–6/6 of the rubric components. Ninety-six percent to 98% of students ‘agreed’ or ‘strongly agreed’ that the curriculum was effective for their learning.

Discussion

For educators in need of an SDH curriculum that is both engaging and effective, we have found this activity to be feasible, low cost, and highly impactful for first year medical students.

Practice points

• Medical education must provide social determinants of health (SDH) teaching.

• Curriculum should be both engaging and interactive.

• Real patient learning deepens the impact of the curriculum.

• Harnessing the expertise of patients leads to feasible, low cost curricular innovation.

Keywords:

• Social determinants of health
• real patient learning
• experiential learning
• case-based learning

Author contributions

Drs. Berger and Harada both designed the curriculum described in the manuscript. They both analyzed the data and drafted the manuscript together. They both approve this version for publication and agree to be accountable for all aspects of the work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

No funding.

Notes on contributors

Stephanie Berger

Stephanie Berger, MD, is a pediatric hospitalist in Birmingham, Alabama. She is passionate about undergraduate medical education and is the assistant director of the pediatric clerkship at the University of Alabama Heersink School of Medicine. She is also a lead mentor of a learning community in the school in addition to co-directing the MS1 module Patient, Doctor and Society.

Caroline Harada

Caroline Harada, MD, is a geriatrician in Birmingham, Alabama. She is the Assistant Dean for Community Engaged Scholarship at the University of Alabama Heersink School of Medicine overseeing service-based learning. She is the course director and curriculum creator for the longitudinal learning community course at the school in addition to being the Patient, Doctor, and Society module director for the MS1s.