Expert Consensus on Inclusion of the Social Determinants of Health in Undergraduate Medical Education Curricula
Karen A Mangold1, Tami R Bartell, Ashti A Doobay-Persaud
1K.A. Mangold is assistant professor, Departments of Pediatrics and Medical Education, Feinberg School of Medicine, Northwestern University, and 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, Division of Hospital Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. M.D. Adler is professor, Departments of Pediatrics and Medical Education, Feinberg School of Medicine, Northwestern University, and 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, and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
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 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 rounds 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 SDH should constitute 29% of the total curriculum 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.
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