From Classroom to Community: the Impact of a Non-Clinical Clerkship on Fourth-Year Medical Students’ Ability to Address Social Determinants of Health
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The AAMC has called for research exploring causes of health disparities and the value of educating health care providers about population health. Research on best practices for educating medical students about social determinants of health is limited.
During academic year 2015–2016, we implemented a required 4-week community health clerkship for all fourth-year medical students at Tulane University not concurrently seeking an MPH. The 15-h classroom component of the course included discussion of reading materials and didactic instruction on social determinants of health, principles of prevention, health disparities, racism, cultural humility, and community health workers’ (CHWs) roles in improving population health. Students also spent 80 h at a community agency doing non-clinical work. In addition to course evaluations, students completed pre-and post-course surveys that included 15 items measuring knowledge and attitudes about patient care and community health on a 4-point Likert scale. Post-course surveys also contained ten open-ended questions.
Students were highly satisfied with the course. There were significant changes in 11 of 15 items related to knowledge and attitudes about patient care and community health. Students reported better understanding of chronic disease causes, physicians’ roles in health promotion, and the roles of CHWs. Students expressed intent to improve their communication skills, address health literacy, contextualize care based on social circumstances, and respond to patients’ cultural health beliefs.
This required 4-week course resulted in significant changes in fourth-year students’ attitudes and knowledge of community health principles.
This course may be a model for other institutions.
KeywordsSocial determinants of health Community health Medical education Cultural humility Population health Health disparities
This work was supported, in part, by the Harry Seneca Charitable Trust. The authors wish to thank Puja Cuddapah and Leigh-Ann Sallis for coordinating the course this paper describes and Meredith Sugarman for providing helpful edits to the paper.
Compliance with Ethical Standards
Informed consent was obtained from all individual participants in the study.
- 1.National Cancer Institute. In: Annual report to the nation on the status of cancer, 1975–2014. 2017 http://www.cancer.gov/research/progress/annual-report-nation. Accessed 16 Nov 2017.
- 3.National Cancer Institute. Cancer health disparities. 2017 http://www.cancer.gov/about-nci/organization/crchd/cancer-health-disparities-fact-sheet. Accessed 16 Nov 2017.
- 5.Association of American Medical Colleges. In: Achieving health equity: How academic medicine is addressing the social determinants of health. 2016. https://www.aamc.org/download/460392/data/sdoharticles.pdf. Accessed 16 Nov 2017.
- 6.Kottke TE, Pronk NP. Taking on the social determinants of health: a framework for action. Minn Med. 2009:36–9.Google Scholar
- 8.Robert Wood Johnson Foundation. Health care’s blind side. 2011. https://www.rwjf.org/en/library/research/2011/12/health-care-s-blind-side.html. Accessed 16 Nov 2017.
- 14.Association of American Medical Colleges. Curriculum inventory: coverage of community health content, 2014–2015. Generated December 14, 2016.Google Scholar
- 16.Laderman M, Mate K. Integrating behavioral health into primary care. Healthc Exec. 2014;29(2):74–7.Google Scholar
- 17.Centers for Medicare and Medicaid Services. MACRA delivery system reform, medicare payment reform. 2017. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html. Accessed 17 Nov 2017.
- 18.American Public Health Association. Support for community health workers to increase health access and to reduce health inequalities. APHA policy statement 2009–1. 2009. https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/09/14/19/support-for-community-health-workers-to-increase-health-access-and-to-reduce-health-inequities. Accessed 17 Nov 2017.