Teaching the Social Determinants of Health in Undergraduate Medical Education: a Scoping Review

• Published in: Journal of general internal medicine : JGIM Vol. 34; no. 5; pp. 720 - 730
• Main Authors: Doobay-Persaud, Ashti, Adler, Mark D., Bartell, Tami R., Sheneman, Natalie E., Martinez, Mayra D., Mangold, Karen A., Smith, Patricia, Sheehan, Karen M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.05.2019; Springer Nature B.V
• Subjects: Community involvement; Curricula; Data processing; Education; Education, Medical, Undergraduate - methods; Faculty, Medical - statistics & numerical data; Humans; Internal Medicine; Logistics; Medical education; Medical personnel; Medical students; Medicine; Medicine & Public Health; Physicians; Program evaluation; Schools, Medical - statistics & numerical data; Social Determinants of Health; Students; Teaching methods; health equity; social determinants of health; undergraduate medical education; scoping review
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-019-04876-0

Background To provide optimal care, medical students should understand that the social determinants of health (SDH) impact their patients’ well-being. Those charged with teaching SDH to future physicians, however, face a paucity of curricular guidance. Objective This review’s objective is to map key characteristics from publications about teaching SDH to students in undergraduate medical education (UME). Methods In 2016, the authors searched PubMed, Embase, Web of Science, the Cochrane and ERIC databases, bibliographies, and MedEdPORTAL for articles published between January 2010 and November 2016. Four reviewers screened articles for eligibility then extracted and analyzed data descriptively. Scoping review methodology was used to map key concepts and curricular logistics as well as educator and student characteristics. Results The authors screened 3571 unique articles of which 22 were included in the final review. Many articles focused on community engagement (15). Experiential learning was a common instructional strategy (17) and typically took the form of community or clinic-based learning. Nearly half (10) of the manuscripts described school-wide curricula, of which only three spanned a full year. The majority of assessment was self-reported (20) and often related to affective change. Few studies objectively assessed learner outcomes (2). Conclusions The abundance of initial articles screened highlights the growing interest in SDH in medical education. The small number of selected articles with sufficient detail for abstraction demonstrates limited SDH curricular dissemination. A lack of accepted tools or practices that limit development of robust learner or program evaluation was noted. Future research should focus on identifying and evaluating effective instructional and assessment methodologies to address this gap, exploring additional innovative teaching frameworks, and examining the specific contexts and characteristics of marginalized and underserved populations and their coverage in medical education.