Secondary Logo

Institutional members access full text with Ovid®

Social Determinants of Health Training in U.S. Primary Care Residency Programs

A Scoping Review

Gard, Lauren A., MPH; Peterson, Jonna, MLIS; Miller, Corrine, MLIS; Ghosh, Nilasha, MD; Youmans, Quentin, MD; Didwania, Aashish, MD; Persell, Stephen D., MD, MPH; Jean-Jacques, Muriel, MD; Ravenna, Paul, MD; O’Brien, Matthew J., MD, MSc; Sanghavi Goel, Mita, MD, MPH

doi: 10.1097/ACM.0000000000002491
Reviews
Buy
SDC

Purpose Medical training has traditionally focused on the proximate determinants of disease, with little focus on how social conditions influence health. The authors conducted a scoping review of existing curricula to understand the current programs designed to teach primary care residents about the social determinants of health (SDH).

Method In January and March 2017, the authors searched seven databases. Eligible articles focused on primary care residents, described a curriculum related to SDH, were published between January 2007 and January 2017, and were based in the United States.

Results Of the initial 5,523 articles identified, 43 met study eligibility criteria. Most programs (29; 67%) were in internal medicine. Sixteen studies (37%) described the curriculum development process. Overall, 20 programs (47%) were short or one-time sessions, and 15 (35%) were longitudinal programs lasting at least 6 months. Thirty-two programs (74%) reported teaching SDH content using didactics, 22 (51%) incorporated experiential learning, and many programs (n = 38; 88%) employed both. Most studies reported satisfaction and/or self-perceived changes in knowledge or attitudes.

Conclusions The authors identified wide variation in curriculum development, implementation, and evaluation. They highlight curricula that considered community and resident needs, used conceptual frameworks or engaged multiple stakeholders to select content, used multiple delivery methods, and focused evaluation on changes in skills or behaviors. This review highlights the need not only for systematic, standardized approaches to developing and delivering SDH curricula but also for developing rigorous evaluation of the curricula, particularly effects on resident behavior.

L.A. Gard is project coordinator, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-3723-8859.

J. Peterson is senior clinical informationist, Department of Medicine, Northwestern University, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-6585-892X.

C. Miller is clinical informationist, Department of Medicine, Northwestern University, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-9262-152X.

N. Ghosh is a resident, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-8799-9309.

Q. Youmans is a resident, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-5818-8091.

A. Didwania is associate professor, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

S.D. Persell is associate professor, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

M. Jean-Jacques is assistant professor, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-2897-4187.

P. Ravenna is assistant professor, Division of Family and Community Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

M.J. O’Brien is assistant professor, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

M.S. Goel is associate professor, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-9445-2400.

To read other New Conversations pieces and to contribute, browse the New Conversations collection on the journal’s website (http://journals.lww.com/academicmedicine/pages/collectiondetails.aspx?TopicalCollectionId=61), follow the discussion on AM Rounds (academicmedicineblog.org) and Twitter (@AcadMedJournal using #AcMedConversations), and submit manuscripts using the article type “New Conversations” (see Dr. Sklar’s announcement of the current topic in the November 2017 issue for submission instructions and for more information about this feature).

Funding/Support: This project is supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services under grant number UH1HP29963, Academic Units for Primary Care Training and Enhancement.

Editor’s Note: This New Conversations contribution is part of the journal’s ongoing conversation on social justice, health disparities, and meeting the needs of our most vulnerable and underserved populations.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Disclaimer: This information or content in this review and its 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, the Health Resources and Services Administration, the U.S. Department of Health and Human Services, or the U.S. Government.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A606.

Correspondence should be addressed to Mita Sanghavi Goel, Department of Medicine, Northwestern University, 750 N. Lake Shore Dr., Chicago, IL 60611; telephone: (312) 695-8630; e-mail: Mita.Goel@nm.org; Twitter: @mita_goel, @NU_NCEAS.

© 2019 by the Association of American Medical Colleges