Developing Postgraduate Curricula Focusing on Social Determinants
A scoping review of social determinants of health curricula in post-graduate medical education by Canadian researchers provides some information that may be useful for creating a curriculum in this area (Canadian Med Ed J. 2019;10:e61-e71). All 12 studies included in the review were from the United States and represented curriculum on social determinants of health developed in departments of internal medicine (n=4), pediatrics (n=4), family medicine (n=2), or multiple departments (n=2). The investigators found that 78% of the curricula improved participant-related outcomes, including improved screening for social determinants of health and referral to support services. Based on recurring themes found among the curricula that led to these improved outcomes, the investigators designed a set of recommendations for the development of postgraduate social determinants of health curriculum (see “Design Elements of a Curriculum on Social Determinants of Health,” below).
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June 2021Examples of particular postgraduate curriculum may also help. An educational tool first published online in 2013 in the Journal for General Internal Medicine, called the “Social Determinants of Health Fast Facts” (www.sgim.org/File Library/JGIM/Web Only/SDH/Social-Determinants-of-Health.pdf), may offer a model to build a low-cost and effective tool for graduate medical education, as was done at the University of Pittsburgh Internal Medicine Residency Program. Investigators at Atlanta’s Emory University developed an experiential module to introduce internal medicine residents at an academic safety net hospital to social determinants of health and health disparities (MedEdPORTAL. 2017;13:10647).
Another strategy may involve including social determinants of health in curricula through consortia-type residency education models in which residents learn online from programs taught by faculty from across the country. Several such consortia exist in otolaryngology and present an evolving way to consider and deliver residency education, as highlighted in a recent article (Otolaryngol Head Neck Surg. 2020;163:70-74). Brett T. Comer, MD, residency program director and associate professor in the division of rhinology and anterior skull base surgery in the department of otolaryngology–head and neck surgery at the University of Kentucky in Lexington, and senior author of the study, said incorporating social determinants within this consortia style of learning would be wonderful if properly executed. “A consortium concept might allow otolaryngologists from different settings to teach and discuss the specific disparities they encounter, while allowing learners to see common themes that occur,” he said.
Design Elements of a Curriculum on Social Determinants of Health
| Format | • Longitudinal exposure through postgraduate training to enable repeated exposure to elements within the program. |
| Content | • Vary content based on the needs of the community. • Use multiple sources (e.g., resident and community needs assessments, local expert opinions, literature reviews). • Include at least a basic introduction to social determinants of health: what they are, how they impact patient care and health outcomes. • Other content could include resources relevant to the socioeconomic status of the patient, patient–provider interaction issues, leadership and health advocacy, interprofessional collaboration, and project management. |
| Learning Activities | • Include multiple types, such as patient or community exposure for hands-on learning supplemented with classroom-based or independent learning. • More rigorous programs may include a resident research or advocacy project. |
| Evaluation Methods | • Comprehensive evaluation methods should be used and should target objectives aimed at participant outcomes, as well as patient-, program-, and academic-related outcomes. |
Source: Canadian Med Ed J. 2019;10:e61-e71.
Integrating Social Determinants into Practice
Raising awareness of and recognizing the social determinants of health and how they are linked to health outcomes is the first step toward advancing better healthcare for all otolaryngology patients. Education is critical to this movement, and determining how to integrate social determinants into the otolaryngology clinic will require careful thought. Among the key questions will be how to define the role of an otolaryngologist in screening patients for factors such as access to transportation, housing, and food. Once screened, what does the otolaryngologist do with that information—what systems are in place to help the otolaryngologist refer patients to the resources they need (CMAJ. 2016;188:E474-E483)?
“This is uncharted territory for most of us,” said Dr. Francis. “Awareness is important, but not enough.” Calling for innovative ways of thinking on how otolaryngologists can evaluate and intervene on the social/structural determinants of health, Dr. Francis underscored the need for otolaryngologists to use their expertise and tools to support community needs and partner with leaders and scholars outside the specialty to learn about programmatic successes in this area.