Assessing Social Determinants of Health Training in Graduate Medical Education: A Narrative Review Using...

Area of Science:

• Medical Education Research
• Public Health Training Evaluation
• Health Equity Curriculum Development

Background:

• Social determinants of health (SDOH) training is crucial for physicians to address socioeconomic factors impacting patient well-being.
• Current SDOH training evaluations predominantly assess lower-level outcomes like learner satisfaction and knowledge, neglecting behavioral and patient impact.
• Kirkpatrick's model provides a framework for evaluating training across four levels: Reaction, Learning, Behavior, and Results.

Purpose of the Study:

• To assess the evaluation methods used in SDOH training programs within graduate medical education.
• To apply Kirkpatrick's model, GRADE quality assessment, and bibliometric network analysis to understand SDOH training efficacy and evidence quality.
• To provide insights for designing SDOH curricula that yield measurable improvements in physician behavior and patient care.

Main Methods:

• A narrative review analyzing 33 studies on SDOH training efficacy in graduate medical education, identified from recent scoping reviews.
• Studies were categorized by the highest Kirkpatrick level achieved (Levels 1/2: Reaction/Learning; Levels 3/4: Behavior/Results).
• Integration of Grading of Recommendations Assessment, Development and Evaluation (GRADE) for evidence quality and bibliometric co-authorship network analysis for collaboration patterns.

Main Results:

• 79% of analyzed studies focused on Kirkpatrick Levels 1/2 (Reaction/Learning), primarily using subjective surveys; only 21% reached Levels 3/4 (Behavior/Results).
• Among Level 3/4 studies, 71% used career tracking as a proxy for behavior change, with only three assessing patient outcomes (Level 4).
• GRADE analysis rated all studies as low or very low quality; bibliometric analysis revealed limited institutional collaboration, with three distinct clusters identified.

Conclusions:

• Most SDOH training evaluations rely on subjective, lower-level outcomes, providing limited insight into real-world impact on clinical practice and health equity.
• The current evidence base for SDOH training is of low quality, highlighting the need for more rigorous study designs, including control groups and objective measures.
• Advancing SDOH education requires longitudinal curricula, patient-centered outcomes, and multi-site collaborations to generate generalizable and impactful evidence.