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Expert Consensus on Inclusion of the Social Determinants of Health in Undergraduate Medical Education Curricula

Mangold, Karen A. MD, MEd; Bartell, Tami R. MPH; Doobay-Persaud, Ashti A. MD; Adler, Mark D. MD; Sheehan, Karen M. MD, MPH

doi: 10.1097/ACM.0000000000002593
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Purpose: Accreditation bodies have mandated teaching social determinants of health (SDH) to medical students, but there has been limited guidance for educators on what or how to teach, and how to evaluate students’ competence. To fill this gap, this study aimed to develop an SDH curricular consensus guide for teaching the SDH to medical students.

Method: In 2017, the authors used a modified Delphi technique to survey an expert panel of educators, researchers, students, and community advocates about knowledge, skills, and attitudes (KSA), and logistics regarding SDH teaching and assessment. They identified the panel and ranked a comprehensive list of topics based on a scoping review of SDH education studies and discussions with key informants. A total of 57 experts were invited.

Results: Twenty-two and 12 panelists participated in Delphi round 1 and 2, respectively. The highest ranked items regarding KSA were: “Appreciation that the SDH are some of the root causes of health outcomes and health inequities” and “How to work effectively with community health workers.” The panel achieved consensus that the SDH should comprise 29% of the total curricula and be taught continuously throughout the curriculum. Multiple-choice tests were ranked lowest as an assessment method and patient feedback was ranked highest. Panelists noted that SDH content must be a part of standardized exams to be prioritized by faculty and students.

Conclusions: An expert panel endorsed essential curricular content, teaching methods, and evaluation approaches that can be used to help guide medical educators regarding SDH curriculum development.

K.A. Mangold is assistant professor, Departments of Pediatrics and Medical Education; Feinberg School of Medicine, Northwestern University; Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois.

T.R. Bartell is research project manager, Mary Ann and J. Milburn Smith Child Health Research, Outreach and Advocacy Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois.

A.A. Doobay-Persaud is assistant professor, Department of Medicine; Feinberg School of Medicine, Northwestern University; Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois.

M.D. Adler is professor, Departments of Pediatrics and Medical Education; Feinberg School of Medicine, Northwestern University; Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois.

K.M. Sheehan is professor, Departments of Pediatrics and Preventive Medicine; Feinberg School of Medicine, Northwestern University; Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A629.

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

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

Other disclosures: To the best of the authors’ knowledge, there is no existing conflict of interest, financial or other, to disclose.

Ethical approval: This study was reviewed by the institutional review boards of the Ann & Robert H. Lurie Children’s Hospital of Chicago (IRB 2017-971, April 8, 2017) and Northwestern University Feinberg School of Medicine (STU00205134, April 18, 2017) and determined to be exempt.

Disclaimer: 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.

Previous presentations: Some preliminary findings from this study were presented in poster format at the Health Disparities & Social Justice Conference on August 8, 2017, in Chicago, Illinois, which was hosted by DePaul University and the Center for Community Health Equity and at the Pediatric Academic Society Meeting on May 5, 2018 in Toronto, Ontario.

Correspondence should be addressed to Karen A. Mangold, Pediatric Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago; 225 E. Chicago Ave, Box 62, Chicago, IL 60611; telephone: (312) 227-6080; email: kmangold@luriechildrens.org.

© 2019 by the Association of American Medical Colleges