Using simulation to increase resident comfort discussing social determinants of health

John M Morrison,Robert A Dudas,Kimberly R Collins,Akshata M Hopkins,Sarah M Marsicek

doi:10.1186/s12909-021-03044-5

Abstract

BackgroundSocial determinants of health (SDoH) play an important role in pediatric health outcomes. Trainees receive little to no training on how to identify, discuss and counsel families in a clinical setting. The aim of this study was to determine if a simulation-based SDoH training activity would improve pediatric resident comfort with these skills.Methods We performed a prospective study of a curricular intervention involving simulation cases utilizing standardized patients focused on four social determinants (food insecurity, housing insecurity, barriers to accessing care, and adverse childhood experiences [ACEs]). Residents reported confidence levels with discussing each SDoH and satisfaction with the activity in a retrospective pre-post survey with five-point Likert style questions. Select residents were surveyed again 9–12 months after participation.Results85% (33/39) of residents expressed satisfaction with the simulation activity. More residents expressed comfort discussing each SDoH after the activity (Δ% 38–47%; all p < .05), with the greatest effect noted in post-graduate-year-1 (PGY-1) participants. Improvements in comfort were sustained longitudinally during the academic year. More PGY-1 participants reported engaging in ≥ 2 conversations in a clinical setting related to food insecurity (43% vs. 5%; p = .04) and ACEs (71% vs. 20%; p = .02).DiscussionSimulation led to an increased resident comfort with discussing SDoH in a clinical setting. The greatest benefit from such a curriculum is likely realized early in training. Future efforts should investigate if exposure to the simulations and increased comfort level with each topic correlate with increased likelihood to engage in these conversations in the clinical setting.

Highlights

Child health is directly influenced by social determinants, or the circumstances in which patients and their families live and work [1, 2]
A total of 48 pediatric residents participated in the simulation exercise (24 per academic year) and 24 residents from the first year of the study were approached for longitudinal questioning
The overall survey response rate of residents opting to have their surveys included in this study was 81% (39/48) for the immediate post-exercise survey and 54% (13/24) for the longitudinal follow-up survey. 83% (20/24) of PGY-1 and 79% (19/24) of PGY-3 trainees were included in the immediate post-exercise survey. 58% (7/12) of PGY-1 and 50% (6/12) of PGY-3 trainees were included in the longitudinal survey

Summary

Introduction

Child health is directly influenced by social determinants, or the circumstances in which patients and their families live and work [1, 2]. Didactic- and immersion-based efforts to provide training to pediatric residents on SDoH have resulted in improved trainee knowledge and comfort with discussing social determinants of health [9]. Informed by our institution’s community health needs assessment, we chose four of the many SDoH around which to develop simulation cases for pediatrics residents [14]. These cases focused on addressing food insecurity, housing insecurity, barriers to accessing health care, and adverse childhood experiences ( ACEs) utilizing simulated parents. We hypothesized that simulation-based training would improve resident self-reported comfort with discussing SDoH in a clinical setting. The aim of this study was to determine if a simulation-based SDoH training activity would improve pediatric resident comfort with these skills

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Conclusion