Development of a Case-Based Social Determinants of Health Curriculum for Graduate Medical Education

Abstract

Introduction

Social Determinants of Health (SDOH) are conditions in environments where people live, learn, work, play, worship, and age that affect a wide range of health, functional, and quality-of-life outcomes and risks, contributing to health disparities and inequities. Several agencies endorse the importance of SDOH, but limited data is available on effective teaching tools for incorporating SDOH into Graduate Medical Education (GME). We developed a case-based curriculum to increase comfort of trainees and faculty in identifying, researching, and educating on SDOH, and utilized it to promote and assess commitment to clinical practice change.

Methods

Kern's six-step methodology guided development of the curricular framework. A selected resident-faculty pair reviewed a subspecialtyspecific case through the lens of an assigned SDOH domain using evidence-based medicine. The pair created an interactive learning module to discuss the case, review evidence, investigate whether the standard of care addresses the SDOH domain, and provide a relevant clinical toolkit item.

Results

Pre-curriculum assessments showed gaps between resident-perceived SDOH education frequency and staff comfort with SDOH education. Qualitative feedback demonstrated that the curriculum improved resident-perceived education and comfort of faculty in educating on subspecialty-specific SDOH. Nearly 50 commitment-to-clinical practice change goals were created.

Conclusion

Integrated SDOH instruction in GME is a priority, but residents report insufficient instruction and faculty feel ill-equipped to provide such education. Our case-based SDOH curriculum presents a dynamic, sustainable, and clinically relevant solution to bridge both gaps and a unique opportunity for programs to reimagine SDOH education and foster a cadre of healthcare professionals equipped to deliver SDOH-competent care.