Social Determinants of Health Training in U.S. Primary Care Residency Programs: A Scoping Review
- 1 January 2019
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Academic Medicine
- Vol. 94 (1), 135-143
- https://doi.org/10.1097/acm.0000000000002491
Abstract
Medical training has traditionally focused on the proximate determinants of disease, with little focus on how social conditions influence health. The authors conducted a scoping review of existing curricula to understand the current programs designed to teach primary care residents about the social determinants of health (SDH). In January and March 2017, the authors searched seven databases. Eligible articles focused on primary care residents, described a curriculum related to SDH, were published between January 2007 and January 2017, and were based in the United States. Of the initial 5,523 articles identified, 43 met study eligibility criteria. Most programs (29, 67%) were in internal medicine. Sixteen studies (37%) described the curriculum development process. Overall, 20 (47%) programs were short or one-time sessions, and 15 (35%) were longitudinal programs lasting at least 6 months. Thirty-two programs (74%) reported teaching SDH content using didactics, 22 (51%) incorporated experiential learning, and many programs (n = 38; 88%) employed both. Most studies reported satisfaction and/or self-perceived changes in knowledge or attitudes. The authors identified wide variation in curriculum development, implementation, and evaluation. They highlight curricula that considered community and resident needs, used conceptual frameworks or engaged multiple stakeholders to select content, used multiple delivery methods, and focused evaluation on changes in skills or behaviors. This review highlights the need not only for systematic, standardized approaches to developing and delivering SDH curricula, but also for developing rigorous evaluation of the curricula, particularly effects on resident behavior.Keywords
This publication has 52 references indexed in Scilit:
- Watch and LearnClinical Pediatrics, 2013
- The Effect of the Hidden Curriculum on Resident Burnout and CynicismJournal of Graduate Medical Education, 2011
- Training in Social Determinants of Health in Primary Care: Does it Change Resident Behavior?Academic Pediatrics, 2011
- A Public Health Approach to Pediatric Residency Education: Responding to Social Determinants of HealthJournal of Graduate Medical Education, 2011
- Closing the gap in a generation: health equity through action on the social determinants of healthThe Lancet, 2008
- Predictive Validity Evidence for Medical Education Research Study Quality Instrument Scores: Quality of Submissions to JGIM’s Medical Education Special IssueJournal of General Internal Medicine, 2008
- We Can Do Better — Improving the Health of the American PeopleThe New England Journal of Medicine, 2007
- Medical Education for a Changing World: Moving Beyond Cultural Competence into Transnational CompetenceAcademic Medicine, 2006
- Measuring nominal scale agreement among many raters.Psychological Bulletin, 1971
- A theory of human motivation.Psychological Review, 1943