Integration of Social Determinants of Health in Undergraduate Medical Education: From Evidence to Implementation

Over the past 50 years, there has been increased awareness of the importance of social determinants of health (SDOH) in undergraduate medical education (UME) curricula. Since the societal guidelines and accreditation standards started to address SDOH topics, it has further evolved to recognize the impacts of SDOH on the medical outcomes for our patients. Medical schools across the United States have been integrating SDOH content across the curriculum in response to expectations from accrediting bodies, guided by national organizations, and fueled by internal efforts of curricular reform and improvement. Since its inception in 2017, our college of allopathic medicine has made SDOH a major pillar in its vertically and horizontally integrated 4-year curriculum. To evaluate the depth and breadth of SDOH integration, we searched "eMedley," our curriculum management system, for content specifically addressing these topics. We identified various curricular activities integrating SDOH-related topics across all 4 years, including hands-on learning projects, as well as small-group discussions and large group discussions with a heavy emphasis on the clinical impact of SDOH. Based on our review of current trends and our experience, we recommend a progressive competency-based transition of SDOH learning and assessment across pre-clerkship, clerkship, and graduate medical education to ensure a meaningful longitudinal learning process.