Teaching Medical Students to Identify Social Determinants of Health Through Observation and Reflection

Social determinants of health (SDOH) impact 80-90% of health outcomes in the United States. To address SDOH, innovative teaching of future healthcare professionals is needed. At one large urban medical school in an area with a high population of underserved individuals, first-year medical students participated in a Service Learning curriculum, assessing community needs in local ZIP Code areas. This single-institution descriptive program evaluation describes the implementation and feasibility of this educational activity and reports students' identified community priorities and self-reported engagement.

During the 2022-2023 academic year, forty-one groups of 6-8 first-year medical students conducted neighborhood observations, then created an 8-10-minute presentation. They selected a key area to address-food, clinics, education, transportation, parks, or other. Faculty, alumni, and students provided feedback on presentations. Students completed two single-item surveys: Survey 1 (administered post-observation) assessed intended area of community engagement focus, and Survey 2 (administered at end of academic year) assessed self-reported community engagement activities.

All 316 students completed the educational activity and Survey 1. Food was most commonly chosen as the intended engagement focus (40.51%), followed by clinic (17.41%), transportation (15.51%), education (13.61%), parks (9.18%), and other (3.80%). Within-group agreement on key issues varied (25-100%), with a mean concordance of 58.52%. Survey 2 was completed by 81 students (25.6% response rate); among respondents, 38.27% reported partnering with community organizations and 35.80% reported expanding access to healthcare services.

This service-learning curriculum demonstrated the feasibility of a large-cohort, neighborhood-based experiential learning activity to introduce first-year medical students to SDOH. Students identified diverse community priorities, with food insecurity most frequently selected. Future studies using validated outcome measures and controlled designs are needed to evaluate the educational effectiveness of this approach.