Abstract
National organizations recommend that medical schools train students in the social determinants of health. To develop and evaluate a longitudinal health equity curriculum that was integrated into third-year clinical clerkships and provided experiential learning in partnership with community organizations. This longitudinal cohort study was conducted from June 2017 to October 2020 to evaluate the association of the curriculum with medical students' self-reported knowledge of social determinants of health and confidence working with underserved populations. Students from 1 large medical school in the southeastern US were included. Students in the class of 2019 and class of 2020 were surveyed at baseline (before the start of their third year), end of the third year, and graduation. The class of 2018 (No curriculum) was surveyed at graduation to serve as a control. Data analysis was conducted from June to September 2020. The curriculum began with a health equity simulation followed by a series of modules. The class of 2019 participated in the simulation and piloted the initial 3 modules (pilot), and the class of 2020 participated in the simulation and the full 9 modules (full). A linear mixed-effects model was used to evaluate the change in the self-reported knowledge and confidence scores over time (potential scores ranged from 0 to 32, with higher scores indicating higher self-reported knowledge and confidence working with underserved populations). In secondary analyses, a Kruskal-Wallis test was conducted to compare graduation scores between the no, pilot, and full curriculum classes. A total of 314 students (160 women [51.0%], 205 [65.3%] non-Hispanic White participants) completed at least 1 survey, including 125 students in the pilot, 121 in the full, and 68 in the no curriculum classes. One hundred forty-one students (44.9%) were interested in primary care. Total self-reported knowledge and confidence scores increased between baseline and end of clerkship (15.4 vs 23.7, P = .001) and baseline and graduation (15.4 vs 23.7, P = .001) for the pilot and full curriculum classes. Total scores at graduation were higher for the pilot curriculum (median, 24.0; interquartile range [IQR], 21.0-27.0; P = .001) and full curriculum classes (median, 23.0; IQR, 20.0-26.0; P = .01) compared with the no curriculum class (median, 20.5; IQR, 16.25-24.0). In this cohort study of medical students, a dedicated health equity curriculum was associated with a significant improvement in students' self-reported knowledge of social determinants of health and confidence working with underserved populations.
Highlights
The social determinants of health (SDH)—the conditions in which people are born, work, live, and age—have a profound effect on morbidity and mortality.[1]
Health Equity Curriculum and Knowledge of Social Determinants of Health. In this cohort study of medical students, a dedicated health equity curriculum was associated with a significant improvement in students’ self-reported knowledge of social determinants of health and confidence working with underserved populations
Concurrent with the implementation, we conducted a longitudinal cohort study to evaluate the association of the curriculum with the students’ selfreported knowledge of the SDH and confidence working with underserved populations
Summary
The social determinants of health (SDH)—the conditions in which people are born, work, live, and age—have a profound effect on morbidity and mortality.[1]. It is imperative that medical schools increase commitment and investment in teaching students about SDH and health equity, and medical school education can have an influence in reducing health disparities.[6,7] Prior studies have found that students who attend medical schools that include health equity curricula are more likely to practice in underserved communities.[8,9,10]. An increasing number of US medical schools have begun to recognize the need for health equity curricula that include issues such as access to care, housing instability, and racial/ethnic bias.[11] National organizations recommend that effective medical school health equity curricula should integrate public health with clinical care, engage with the community, and partner with key community organizations addressing patient needs.[4] these curricula should involve long-term evaluation to determine how they modify students’ behaviors and meet students’ needs.[12,13]
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