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Social Determinants of Health Training in U.S. Primary Care Residency Programs: A Scoping Review
Lauren A Gard1, Jonna Peterson, Corrine Miller
1L.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.
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.
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