scholarly journals Students’ understanding of social determinants of health in a community-based curriculum: a general inductive approach for qualitative data analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sachiko Ozone ◽  
Junji Haruta ◽  
Ayumi Takayashiki ◽  
Takami Maeno ◽  
Tetsuhiro Maeno
Keyword(s):  
Data Analysis ◽  
Medical Students ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Rural Areas ◽  
Qualitative Data ◽  
Determinants Of Health ◽  
Qualitative Data Analysis ◽  
Community Based ◽  
Inductive Approach

Abstract Background A community-based medical education (CBME) curriculum may provide opportunities to learn about the social determinants of health (SDH) by encouraging reflection on context, but the categories that students can learn about and their level of reflection are unclear. We aimed to analyze medical students’ understanding and level of reflection about SDH in a CBME curriculum. Methods Study design: General inductive approach for qualitative data analysis. Education Program: All 5th-year and 6th-year medical students at the University of Tsukuba School of Medicine in Japan who completed a mandatory 4-week clinical clerkship in general medicine and primary care during October 2018 and May 2019 were included. The curriculum included 3 weeks of rotations in community clinics and hospitals in suburban and rural areas of Ibaraki Prefecture. On the first day, students learned about SDH through a lecture and a group activity. As an SDH assignment, they were instructed to prepare a structural case description using the Solid Facts framework based on encounters during the curriculum. On the final day, they submitted the structural reflection report. Analysis: Content analysis was based on the Solid Facts framework. Levels of reflection were categorized as reflective, analytical, or descriptive. Results We analyzed 113 SDH case descriptions and 118 reports. On the SDH assignments, the students frequently reported on social support (85%), stress (75%), and food (58%), but less frequently on early life (15%), unemployment (14%), and social gradient (6%). Of the 118 reports, 2 were reflective, 9 were analytical, and 36 were descriptive. The others were not evaluable. Conclusions The CBME curriculum enabled medical students to understand the factors of SDH to some extent. Further work is needed to deepen their levels of reflection.

scholarly journals Endocrinology in the Time of Coronavirus: A Virtual Endocrinology Elective for Medical Students

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A340-A341
Author(s):  
Meaghan C Moxley ◽  
Elizabeth Lamos ◽  
Rana Malek
Keyword(s):  
Medical Students ◽  
Patient Care ◽  
Student Satisfaction ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Diabetes Care ◽  
Core Competencies ◽  
Determinants Of Health ◽  
The Impact

Abstract Introduction: During the COVID-19 pandemic, the Association of American Medical Colleges recommended that medical students halt in-person learning. Our institution created a competency based virtual endocrinology elective to provide continued clinical experience with a focus on type 2 diabetes (T2DM) and health equity in diabetes care. Methods: A 4-week virtual endocrinology elective alternated between different mini-rotations to maximize exposure to inpatient and outpatient endocrine care, as well as self-directed and faculty/fellow directed educational experiences. Post-elective surveys assessed student satisfaction with elective components and change in comfort levels with T2DM management and social determinants of health (SDH) on diabetes care. Results: Overall, 87% (n=13) of students were “extremely satisfied” with the elective. Increased comfort was seen with management of type 2 DM and the impact of SDH on DM care (DM 88% neutral/uncomfortable to 94% comfortable, SDH 50% neutral/uncomfortable to 94% comfortable). Students were satisfied with the quality of patient care and requested opportunities for more direct involvement. Conclusions: This virtual endocrine elective shows that curricula can be creatively designed to educate students in endocrinology, assess students across core competencies, and demonstrate impacts of telehealth and social determinants of health on endocrine and patient care.

scholarly journals Frailty in older adults and their association with social determinants of Health. The SABE Colombia Study

2019 ◽  
pp. 89-101 ◽  
Author(s):  
José M Ocampo Chaparro ◽  
Carlos A Reyes Ortiz ◽  
Ximena Castro Flórez ◽  
Fernando Gómez
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Rural Areas ◽  
Cross Sectional Study ◽  
Determinants Of Health ◽  
Cross Sectional ◽  
Childhood Health ◽  
The Social ◽  
Urban And Rural Areas ◽  
The Relationship

Objective: To estimate the prevalence of frailty and evaluate the relationship with the social determinants of health in elderly residents in urban and rural areas of Colombia. Methods: The SABE (Health, Wellbeing, and Aging) Colombia project is a cross-sectional study, carried out in 2014-2015, involving 24,553 men and women aged 60 years and older who live in the community in Colombia. For this analysis, we used data from 4,474 participants included as a subsample with grip strength measurements. The frailty syndrome was diagnosed according to the Fried criteria (weakness, low speed, low physical activity, exhaustion, and weight loss). The independent variables were grouped as (a) biological and genetic flow, (b) lifestyle (adverse conditions in childhood) (c) social networks and community, and (d) socio-economic, cultural and environmental conditions. Multiple logistic and linear regression analyses were used to assess the prognostic value of frailty for the outcomes of interest. Results: The prevalence of frailty was 17.9%. The factors significantly associated with frailty were older age, being women, living in rural areas, having low education, a greater number of medical conditions, insufficient current income, childhood health problems and a poor economic situation in childhood. Conclusions: Our results support the need to include frailty prevention programs, to improve the socioeconomic health conditions of infants to avoid future development of frailty.

scholarly journals Integration and social determinants of health and wellbeing for people from refugee backgrounds resettled in a rural town in South Australia: a qualitative study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anna Ziersch ◽  
Emily Miller ◽  
Melanie Baak ◽  
Lillian Mwanri
Keyword(s):  
Rural Communities ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Rural Areas ◽  
Social Connectedness ◽  
South Australia ◽  
Determinants Of Health ◽  
Rural Setting ◽  
Snowball Sampling ◽  
Health And Wellbeing

Abstract Background There has been a recent focus on resettlement of migrants and refugee in rural settings in Australia and elsewhere. Rural resettlement is seen as an opportunity to revitalise rural communities, to fill the needs of employers in these areas, and to provide a welcoming community within which new arrivals can integrate and settle. However, challenges to rural resettlement have been identified including difficulties securing employment, discrimination and social isolation. These challenges can affect resettlement outcomes including health and wellbeing, though relatively little research has examined these links. In this paper we explored experiences of people from refugee background settling in a rural Australian town, examining interconnections between social determinants of health (SDH) and integration. Methods Face-to-face interviews were conducted with 44 participants from Southeast Asia and Africa in a rural setting in South Australia, covering experiences of resettlement and impacts on health and wellbeing. Participants were recruited through existing connections within the community and snowball sampling. Audio recorded data were transcribed verbatim and analysed using framework thematic analysis. Results The study findings revealed a mixture of settlement experiences for participants across a range of elements of SDH and integration. A sense of safety and some elements of social connectedness and support were key enablers for integration and health and wellbeing, with main challenges including limitations in employment opportunities, mismatched education provision, experiences of discrimination and constrained access to services. Conclusions Challenges experienced by refugees resettled in rural areas can affect integration, health and wellbeing and subsequent onward migration intentions. Attention to broader socioeconomic, cultural and environmental conditions, alongside tailored settlement support policies and practices for individual rural resettlement sites, is required to support integration and health and wellbeing.

scholarly journals Missing the target? Teaching undergraduate medical students to “go upstream” and advocate on social determinants of health

2019 ◽  
Author(s):  
Kate Hayman ◽  
Mei Wen ◽  
Farooq Khan ◽  
Tracey Mann ◽  
Andrew D. Pinto ◽  
...  
Keyword(s):  
Medical Students ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Pilot Project ◽  
Determinants Of Health ◽  
Structural Factors ◽  
Political Systems ◽  
Undergraduate Medical Students ◽  
Medical Trainees ◽  
Specific Skill

We describe a pilot project aimed at teaching advocacy skills to pre-clinical medical students, using the lens of the social determinants of health. During the pilot, students were tasked with performing a mock deputation to a policymaker and writing an opinion editorial piece for a lay audience. Students excelled in identifying the relevant social and structural factors impacting health, yet demonstrated uncertainty about how to identify, approach and best influence stakeholders around policy change. To be effective health advocates, medical trainees require training in specific advocacy skills such as oral and written communication, however this alone may be insufficient. As future advocates, medical trainees must also acquire a specific skill set to navigate the complex political systems in which they will practice.    

scholarly journals An Evaluation of Cascading Mentorship as Advocacy Training in Undergraduate Medical Education 

2020 ◽  
Author(s):  
Mitesh Patel ◽  
Devon Aitken ◽  
Yunlin Xue ◽  
Sanjeev Sockalingam ◽  
Alexander Simpson
Keyword(s):  
At Risk ◽  
Medical Education ◽  
Content Analysis ◽  
Medical Students ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
At Risk Youth ◽  
Advocacy Training ◽  
Youth Advocacy

Abstract Background Physicians are in a position of great influence to advocate for health equity. As such, it is important for physicians-in-training to develop the knowledge and skills necessary to fulfil this role. Although various undergraduate medical programs have implemented health advocacy training, they often lack experiential learning and physician involvement. These aspects are foundational to the Advocacy Mentorship Initiative (AMI) which utilizes cascading mentorship as a novel approach to advocacy training. Medical students develop advocacy competency as peer mentors to youth raised in at-risk environments, while also being mentored themselves by physician residents. We aim to determine whether there are specific advantages to utilizing cascading mentorship to facilitate the attainment of advocacy competencies in undergraduate medical education. Methods Medical students participating in AMI between 2017 to 2020 completed pre- and post-exposure questionnaires. Questionnaires assessed confidence in advocacy-related skills and knowledge of youth advocacy concepts, as well as learning goals, skills gained, benefits of AMI and resident mentors, and impact on future career. Sign tests were utilized to analyze quantitative results, and content analysis was used for open-ended responses. A triangulation protocol was also utilized. Results Fifty mentors participated, 24 (48%) of which completed both pre- and post-exposure questionnaires. Participants gained confidence in advocacy-related skills (p<0.05) such as working with vulnerable populations and advocating for medical and non-medical needs. They also reported significant improvements (p<0.01) in their understanding of social determinants of health and concepts related to children’s health and development. Content analysis showed that participants built meaningful relationships with mentees in which they learned about social determinants of health, youth advocacy, and developed various advocacy-related skills. Participants greatly valued mentorship by residents, identifying benefits such as support and advice regarding relations with at-risk youth, and career mentorship. AMI impacted participants’ career trajectories in terms of interest in working with youth, psychiatry, and advocacy. Conclusions AMI offers a unique method of advocacy training through cascading mentorship that engages medical students both as mentors to at-risk youth and mentees to resident physicians. Through cascading mentorship, medical students advance in their advocacy-related skills and understanding of social determinants of health.

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