Integrating Social Drivers of Health into Topic-Based Education for Internal Medicine Residents: A Faculty...

Graduate medical education (GME) on social drivers of health (SDOH) is critical to prepare residents in providing comprehensive clinical care but is usually delivered as standalone teaching on health equity.

To examine faculty educators' preparedness to integrate SDOH into core didactics of the residency curriculum, identify barriers, test the effect of brief tailored interventions on faculty's willingness to incorporate SDOH into teaching, and capture resident perspectives on SDOH education.

This mixed-methods educational research was conducted from 5/2024 to 5/2025 in an Internal Medicine residency program, and consisted of a qualitative needs assessment, a tailored faculty development intervention, and quantitative evaluation of faculty and learner outcomes. Content expert faculty joined pre-didactic interviews and focus groups to discuss knowledge, comfort, and barriers to incorporating SDOH, which were addressed with brief tailored interventions. Thematic analyses of transcripts were performed. Post-didactic faculty surveys assessed incorporation of SDOH. Residents completed pre- and post-curriculum surveys evaluating impact.

Twenty-eight faculty experts across multiple subspecialties participated. Five themes emerged: uncertainty about integration, conflation of race with SDOH, discomfort defining race, limited awareness of SDOH literature, and effective attention to SDOH-integrated patientcare. Tailored interventions prompted engagement and provided feasible teaching approaches. Most (26/28) faculty experts subsequently incorporated SDOH into lectures, citing improved knowledge about SDOH. Among 157 residents, 46% responded to surveys showing significant increases in self-reported application of SDOH in patientcare (p < 0.001) and departure from genetic explanations of racial disparities (p = 0.01).

Faculty acknowledged uncertainty and discomfort discerning race and SDOH in published data, and teaching about SDOH relevant to topics they are clinical experts in. Embedding SDOH into disease-specific didactics, reinforced by brief faculty development, proved practical and valued by both educators and learners. Such integration can strengthen residency training by aligning clinical education with the realities of patient care.