ENRICHING EDUCATION ON SOCIAL DETERMINANTS OF HEALTH: A RESIDENT-DRIVEN, MULTIMODAL CURRICULUM FOR INTERNAL MEDICINE RESIDENTS

ABSTRACT

SETTING AND PARTICIPANTS: The curriculum was offered to Internal Medicine (IM) residents and took place in Boston and surrounding communities. DESCRIPTION This program was developed by IM residents in collaboration with clinical education faculty, physician leaders in health equity, and community partners. It identifies and enhances multiple aspects of residency training to reinforce learning on Social Determinants of Health (SDH). Our curriculum offers four key components. 1) Dedicated discussion of health disparities and institutional/community resources incorporated into existing ambulatory curriculum modules. 2) Resident-led walking tours of neighborhoods around Health Centers focused on the history, health disparities, and resources unique to each community. 3) Residency-wide conferences featuring healthcare innovations that address social determinants of health, including a community health van delivering COVID-19 tests and vaccines. 4) A novel resident-designed, two week elective incorporating patient-centered work with community based initiatives to allow identification of social determinants and tangible work to reduce their adverse effects on health. EVALUATION Quantitative evaluations are assessed via pre- and postinnovation surveys. Sixty-nine of 85 (81%) interns completed the preinnovation survey. Only 56% felt that their prior SDH education was adequate and 25% felt that they had a good understanding of health disparities in Boston. Merely 4% were familiar with resources available in the local healthcare system. Over 98% of responders indicated interest in learning more about health disparities in Boston and available resources to address SDH needs. A post-innovation survey will be distributed after the first year of the curriculum. One of three planned community walking tours has been piloted with positive feedback. Further qualitative feedback will be collected as more walking tours and ambulatory lectures are completed. Feedback on conferences by guest speakers will be collected by the residency via focus groups. DISCUSSION / REFLECTION / LESSONS LEARNED The environment in which individuals live, work, and build community;access to adequate housing, healthy food, living wages, social support, and healthcare;language and marginalization affect health. Understanding how these social determinants impact health outcomes, leveraging community resources to address them, and advocating for health equity are essential elements of the practice of medicine and residency training. This sentiment is reflected in our survey of interns and in the ACGME Guidelines. An effective way of incorporating SDH education into residency training is via a multimodal resident-led initiative that helps residents identify social determinants and describe programs that reduce their adverse impact on health. This initiative began as two residents' interest in learning more about their community and patients. It now serves as a model for weaving SDH into GME curriculum through didactics, conferences, community focused tours, and a clinical elective.