A Community Mural Tour: Facilitating Experiential Learning About Social Determinants of Health

To successfully provide effective patient care within a healthcare system and broader society facing health inequities and social injustice, emergency medicine (EM) residents must demonstrate a nuanced understanding of social determinants of health (SDOH). Classroom or bedside instruction may be insufficient to generate meaningful engagement with patients' social contexts; experiential collaborative learning with community engagement has been suggested as an ideal modality for education about SDOH. We describe a low-cost, easily replicable activity involving observation and discussion of community murals within built environments. The tour was planned by EM faculty with expertise in graduate medical education, social EM, and the use of art in medical education. Prior to the activity, faculty selected murals situated in a variety of neighborhoods that would spark discussion on SDOH. Over the two-hour tour, residents stopped at city murals on a pre-planned route and engaged in observation and discussion. Faculty facilitators used established arts pedagogy, including visual thinking strategies and the concept of the "third thing," to facilitate a collaborative exploration of murals, surrounding communities, and larger implications for patients. The activity was successful in providing residents with a nuanced, context-specific approach to SDOH, sparking greater curiosity about the communities they serve, and engaging residents in reflection and conversation about personal preconceptions and how to better engage with surrounding communities. Since murals and street art are present and accessible in many different settings, residency programs could consider implementing a similar activity as part of their didactic curriculum.