Original Publication
Open Access

From Identification to Advocacy: A Module for Teaching Social Determinants of Health

Published: November 6, 2015 | 10.15766/mep_2374-8265.10266

Included in this publication:

  • Instructor's Guide.docx
  • Appendix 1 Social Determinants of Health.ppt
  • Appendix 2 Small Group Guide.docx
  • Appendix 3 Macrosystem Advocacy.pptx
  • Appendix 4 Student Assignments.docx
  • Appendix 5 Additional Curricular Resources.docx

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.


Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.

Abstract

Introduction: There is growing agreement that physician advocacy is important and is a part of medical professionalism. The specialty societies of internal medicine and pediatrics include advocacy as part of professional responsibilities, and it is currently becoming integrated in residency education and training. The purpose of this resource is to provide learners with an introduction to social determinants of health and patient advocacy. The elements of this multidimensional curriculum may be used together or separately based on the needs of the learners and the institutional resources available. Methods: In a modified flipped-classroom approach, students are given readings to complete prior to small group sessions of 8 to 15 students. Students are expected to contribute to the learning occurring in the small group session through dialogue, discussion, and group project work. Students are then given assignments to apply the curriculum in outpatient, inpatient, and home care settings. Results: Two medical school classes (approximately 180 students) have completed this curriculum at this time. We asked students to evaluate the effectiveness of this curriculum on their learning with a pre- and postcurricula self-assessment. Using a five-point Likert scale, students were asked to rate their skill level with each objective (1 = unfamiliar/never used it; 5 = use with ease). Students were given the same self-assessment before and after the coursework. Seventy-eight students responded to the precourse survey. Fifty students responded to the postcourse survey. Average reported skill level increased by at least 0.4 points for all skill levels. Notably, in the precourse survey, students rated their skill level lowest in identifying resources and collaborating for system change (2.3 and 2.0, respectively). These also were the skills that students rated themselves as most improved at (increase in 0.60 and 0.76 Likert points, respectively) on the postcourse survey. Discussion: The purpose of this resource is to provide learners with an introduction to social determinants of health and patient advocacy. This curriculum has been implemented and evaluated for medical students, but it is broadly applicable to interprofessional students and residents in health-related fields. It includes an interprofessional practice component.


Educational Objectives

By the end of this session, learners will be able to: 

  1. Demonstrate actions that place the patient’s interest first (primacy of the patient). 
  2. Define social determinants of health and describe biological and sociological mechanisms through which the determinants of health operate. 
  3. Screen patients for social risk factors that affect their health and well-being. 
  4. List ways of identifying local government, social service, and neighborhood resources. 
  5. Apply knowledge of social determinants and risk factors to make appropriate referrals to resources. 
  6. Collaborate with colleagues and organizations to effect systemic change at community, state, national, or international levels. 

Author Information

  • Morgan McDonald, MD: Vanderbilt University School of Medicine
  • Jule West, MD: Vanderbilt University School of Medicine
  • Tiffany Israel, MSSW: Vanderbilt University School of Medicine

Disclosures
None to report.

Funding/Support
None to report.


References

  1. Caring With Compassion Web site. https://caringwithcompassion.org. Accessed June 30, 2015.
  2. Choksi DA. Teaching about health disparities using a social determinants framework. J Gen Intern Med. 2010;25(suppl 2):S182-S185. http://dx.doi.org/10.1007/s11606-009-1230-3
  3. Cruess RL, Cruess SR. Teaching medicine as a profession in the service of healing. Acad Med. 1997;72(11):941-952. http://dx.doi.org/10.1097/00001888-199711000-00009
  4. Earnest MA, Wong SL, Federico SG. Physician advocacy: what is it and how do we do it? Acad Med. 2010;85(1):63-67. http://dx.doi.org/10.1097/ACM.0b013e3181c40d40
  5. Flynn MB. Power, professionalism, and patient advocacy. Am J Surg. 1995;170(5):407-409. http://dx.doi.org/10.1016/S0002-9610(99)80318-3
  6. Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree. Washington, DC: Liaison Committee on Medical Education; 2008.
  7. Gruen RL, Pearson SD, Brennan TA. Physician-citizens—public roles and professional obligations. JAMA. 2004;291(1):94-98. http://dx.doi.org/10.1001/jama.291.1.94
  8. Marmot M, Friel S, Bell R, Houweling TAJ, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661-1669. http://dx.doi.org/10.1016/S0140-6736(08)61690-6
  9. Physician Advocacy Program overview. Institute on Medicine as a Profession Web site. http://imapny.org/physician-advocacy/physician-advocacy-program-overview. Accessed June 30, 2015.
  10. Playspent Web site. http://playspent.org. Accessed June 30, 2015.
  11. Smith WR, Betancourt JR, Wynia MK, et al. Recommendations for teaching about racial and ethnic disparities in health and health care. Ann Intern Med. 2007;147(9):654-665. http://dx.doi.org/10.7326/0003-4819-147-9-200711060-00010


Citation

McDonald M, West J, Israel T. From identification to advocacy: a module for teaching social determinants of health. MedEdPORTAL. 2015;11:10266. https://doi.org/10.15766/mep_2374-8265.10266