Teaching the social determinants of health through medical legal partnerships: a systematic review

Abstract Background Undergraduate and graduate medical education often includes the social determinants of health, but questions remain regarding how best to ensure that trainees become empowered to take action on the social determinants of health in their future practice. The authors conducted a systematic review to better define the impact that educational programs centered on medical legal partnerships have on trainees’ knowledge, attitudes and future practice. The authors sourced data from PubMed, Web of Science, Index to Legal Periodicals, LegalTrac, Google Scholar, Academic Search Complete, Business Source Complete, SocINDEX, SSRN, and Proquest Social Sciences. Selected studies included those centered on Medical Legal Partnerships in undergraduate or graduate medical education and that measured outcomes of the participating trainees. Two abstractors independently extracted information about the study population, setting, design, intervention and outcomes. Results Six out of 483 studies met the inclusion criteria. One study highlighted four different MLPs, thus nine total MLP programs were included. Trainees included medical students as well as interns and residents from pediatrics, family medicine and internal medicine. Interventions ranged from didactic sessions, to advocacy projects, to hands-on community-based learning, to poverty simulation trainings. Benefits to trainees were wide in scope but all programs showed improvements in participants’ understanding, comfort, confidence, and/or abilities in identifying and intervening on the social determinants of health in their patients. Conclusion As medical schools and residency programs are increasingly considering how to effectively teach trainees to understand and address the social determinants of health, the findings in this systematic review suggest that inclusion of Medical Legal Partnerships into training programs is an effective approach.

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Teaching the Social Determinants of Health Through Medical Legal Partnerships: A Systematic Review

10.21203/rs.3.rs-130181/v1 ◽

2021 ◽

Author(s):

Benjamin Robinson ◽

Kristian Welch ◽

Michaela Martin ◽

Amy Salerno ◽

Drew Harris

Keyword(s):

Systematic Review ◽

Medical Education ◽

Social Determinants Of Health ◽

Graduate Medical Education ◽

Social Determinants ◽

Determinants Of Health ◽

Systemic Review ◽

Graduate Medical ◽

The Social ◽

Future Practice

Abstract Background: Medical education is increasingly focused on the social determinants of health (SDoH), but questions remain regarding how best to ensure that trainees become empowered to take action on the SDoH in their future practice. The authors conducted a systematic review to better define the impact that educational programs centered on medical legal partnerships (MLP) have on trainees’ knowledge, attitudes and future practice. Methods: The authors sourced data from PubMed, Web of Science, Index to Legal Periodicals, LegalTrac, Google Scholar, Academic Search Complete, Business Source Complete, SocINDEX, SSRN, and Proquest Social Sciences. Selected studies included those centered on Medical Legal Partnerships in graduate medical education and that measured outcomes of the participating trainees. Two abstractors independently extracted information about the study population, setting, design, intervention and outcomes. The literature search was conducted in 2019. Results: Six out of 483 studies met the inclusion criteria. One study highlighted three different MLPs, thus eight total MLP programs were included. Trainees included residents from pediatrics, family medicine and internal medicine. Interventions ranged from didactic sessions, to advocacy projects, to hands-on community-based learning, to poverty simulation trainings. Benefits to trainees were wide in scope but all programs showed improvements in participants’ understanding, comfort, confidence, and/or abilities in identifying and intervening on SDoH in their patients. Conclusion: As undergraduate and graduate medical education is increasingly considering how to effectively teach trainees to understand and address SDoH, the findings in this systemic review suggest that inclusion of Medical-Legal Partnerships into training programs is an effective approach.

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Integrating Social Determinants of Health Into Graduate Medical Education

Academic Medicine ◽

10.1097/acm.0000000000002054 ◽

2018 ◽

Vol 93 (2) ◽

pp. 159-162 ◽

Cited By ~ 19

Author(s):

Jennifer Siegel ◽

David L. Coleman ◽

Thea James

Keyword(s):

Medical Education ◽

Social Determinants Of Health ◽

Graduate Medical Education ◽

Social Determinants ◽

Determinants Of Health ◽

Graduate Medical

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Using a Poverty Simulation in Graduate Medical Education as a Mechanism to Introduce Social Determinants of Health and Cultural Competency

Journal of Graduate Medical Education ◽

10.4300/jgme-d-16-00776.1 ◽

2017 ◽

Vol 9 (3) ◽

pp. 386-387 ◽

Cited By ~ 4

Author(s):

Michael S. Maguire ◽

Renee Kottenhahn ◽

Loretta Consiglio-Ward ◽

Arlene Smalls ◽

Robert Dressler

Keyword(s):

Medical Education ◽

Social Determinants Of Health ◽

Cultural Competency ◽

Graduate Medical Education ◽

Social Determinants ◽

Determinants Of Health ◽

Graduate Medical

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Mobile Health Interventions to Support Caregivers of Older Adults: An Equity-Focused Systematic Review (Preprint)

10.2196/preprints.33085 ◽

2021 ◽

Author(s):

Anna Garnett ◽

Melissa Northwood ◽

Justine Ting ◽

Ruheena Sangrar

Keyword(s):

Systematic Review ◽

Older Adults ◽

Social Determinants Of Health ◽

Mobile Health ◽

Social Determinants ◽

Determinants Of Health ◽

Health Technologies ◽

Health And Wellbeing ◽

The Social ◽

The Impact

BACKGROUND Caregivers provide crucial support to older adults so they can remain safely in their homes as they age. Over time, caregivers’ own health can be negatively impacted by their caregiving role. The social determinants of health, such as gender and socioeconomic status, can influence assuming a caregiving role as well as the impacts of caregiving on the caregiver. While programs exist to support caregivers, uptake of these services does not match the need for services expressed by caregivers. Research suggests that supportive interventions offered via mobile health technologies have the potential to increase caregiver accessibility of supportive services. However, a knowledge gap exists regarding the extent to which the social determinants of health are considered in the design, implementation, and evaluation of mobile health (mHealth) interventions intended to support caregivers of older adults. Furthermore, a comprehensive review of the impact of mHealth interventions in this population does not exist. OBJECTIVE To conduct a systematic review to: (1) determine how health inequities are considered in the design, implementation, and evaluation of mHealth interventions for caregivers of older adults using Cochrane-Equity's PROGRESS-Plus framework; and (2) synthesize evidence of the impacts of caregiver-focused mHealth interventions. METHODS A systematic review was conducted in five databases and articles published between January 2010 and June 2021 were included if they evaluated or explored the impacts of mHealth interventions on the health and wellbeing of informal caregivers of older adults. mHealth interventions were defined as those that caregivers of older adults accessed via mobile or wireless devices. RESULTS A total of 28 articles met the inclusion criteria and were included in the systematic review. The interventions evaluated by the included studies sought to help caregivers make connections with services, facilitate the caregiving process, and promote the caregivers’ health and wellbeing. The PROGRESS-Plus framework factors were mainly considered in the results, discussion, and limitations sections of included studies. Some PROGRESS-Plus factors such as sexual orientation, religion and occupation, received little to no consideration in all phases of intervention design, implementation, or evaluation. Overall, findings of this review suggest that mHealth interventions were positively received by users. Such interventions may have the potential to reduce caregiver burden and positively impact caregivers’ physical and mental health while supporting them in their caregiving role. Study findings highlight the importance of available supports to help facilitate caregivers’ use of mHealth interventions particularly early on as well as the use of appropriate language and text. CONCLUSIONS Successful uptake and spread of mHealth interventions to support caregivers of older adults will depend on creating opportunities for inclusive involvement of a broad range of stakeholders at all stages of design, implementation, and assessment. CLINICALTRIAL PROSPERO CRD42021239584; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=239584

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Health Equity in Graduate Medical Education: Exploring Internal Medicine Residents' Perspectives on a Social Determinants of Health Curriculum

Journal of Health Care for the Poor and Underserved ◽

10.1353/hpu.2020.0147 ◽

2020 ◽

Vol 31 (4S) ◽

pp. 154-162

Author(s):

Mobola Campbell ◽

Aashish Didwania

Keyword(s):

Internal Medicine ◽

Medical Education ◽

Social Determinants Of Health ◽

Health Equity ◽

Graduate Medical Education ◽

Social Determinants ◽

Determinants Of Health ◽

Health Curriculum ◽

Graduate Medical ◽

Internal Medicine Residents

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A Faculty Development Graduate Medical Education Retreat to Teach and Address Social Determinants of Health

Journal of Medical Education and Curricular Development ◽

10.1177/2382120520915495 ◽

2020 ◽

Vol 7 ◽

pp. 238212052091549

Author(s):

Johanna Martinez ◽

Alice Fornari ◽

Venice VanHuse ◽

Ethan Fried ◽

Omolara T Uwemedimo ◽

...

Keyword(s):

Medical Education ◽

Social Determinants Of Health ◽

Graduate Medical Education ◽

Social Determinants ◽

Determinants Of Health ◽

Clinical Workflow ◽

Graduate Medical ◽

Positive Attitudes ◽

Faculty Educators ◽

Program Description

Background: Social determinants of health (SDH) account for a large percentage of health outcomes. Therefore, ensuring providers can address SDH is paramount yet curricula in this area is limited. Aim: The authors aimed to raise awareness, identify learning opportunities, foster positive attitudes, and equip educators to implement SDH curriculum. Setting and participants: This retreat occurred at a large academic institution and had over 130 participants who represented 56 distinct training programs and over 20 disciplines. Program description: The retreat was titled “Social Determinants of Health: Walking in Your Patients’ Shoes.” The retreat was holistic and used a multidimensional approach that included traditional learning, team-based learning, reflective practice, and prompted action. Program evaluation: The evaluation of this retreat included electronic surveys and both qualitative and quantitative data. The retreat’s quality and effectiveness at improving participants’ knowledge and skill in addressing SDH was highly rated and resulted in numerous programs, including surgical and subspecialty programs reporting adopting SDH curricular and clinical workflow changes. Discussion: The retreat was successful and reached a wide and diverse set of faculty educators and can serve as an education model to the graduate medical education community on how to start to develop “physician-citizens.”

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A scoping review of social determinants of health curricula in post-graduate medical education

Canadian Medical Education Journal ◽

10.36834/cmej.61709 ◽

2019 ◽

Vol 10 (3) ◽

pp. e61-71

Author(s):

Kimberly Anne Hunter ◽

Ben Thomson

Keyword(s):

Medical Education ◽

Social Determinants Of Health ◽

Graduate Medical Education ◽

Social Determinants ◽

Scoping Review ◽

The United States ◽

Course Evaluation ◽

Determinants Of Health ◽

Post Graduate ◽

Graduate Medical

Social determinants of health are responsible for 50% of ill health. The Royal College of Physicians and Surgeons of Canada CanMEDS role of “physician advocate” requires physicians to attain competency in this particular domain, but physician trainees feel this is not well covered in their training programs. This study performed a scoping review of social determinants of health curricula that had been described, implemented and evaluated in post-graduate medical education. A search using MEDLINE(OvidSP) database, with search terms “residency,” ”curriculum,” and “social determinants” with no age, language, and publication date restrictions was done.Researchers identified a total of 12 studies, all from the United States, in internal medicine (n=4), pediatrics (n=4), family medicine (n=2), or multiple (n=2) residency programs. Most curricula (n=8, 67%), were longitudinal, and most contained both patient or community exposure (n=11, 92%) and/or classroom-based components (n=10, 83%). Most (78%) curricula improved participant related outcomes, including exam performance, awareness regarding personal practice, confidence, improved screening for social determinants of health and referral to support services. Program specific outcomes were frequently positive (50%) and included resident satisfaction and high course evaluation scores, high representation of resident and faculty from minority groups, applicability of training to underserviced populations, and improved engagement of marginalized community members. When evaluated, academic outcomes were always positive, and included acceptance of scholarly projects to national conferences, publication of research work, grants earned to support health projects, local or national awards for leadership and community engagement, and curriculum graduates later pursuing related Masters degrees and/or establishing medical practices in underserved areas. Only one study reported a patient-related outcome, with advice provided by health care providers considered by patients to be helpful. Researchers used these results to design recommendations for creation of a post-graduate curriculum to address social determinants of health were provided.

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Impact of the Peace Agreement on the social determinants of health in Colombia

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2020-0892 ◽

2021 ◽

Vol 74 (2) ◽

Author(s):

Edna Johana Mondragón-Sánchez ◽

Reinaldo Gutiérrez Barreiro ◽

Marcos Venícios de Oliveira Lopes ◽

Ana Karina Bezerra Pinheiro ◽

Priscila de Souza Aquino ◽

...

Keyword(s):

Social Determinants Of Health ◽

Social Determinants ◽

Social Inequalities ◽

Positive Impact ◽

Peace Process ◽

Determinants Of Health ◽

Structural Determinants ◽

Peace Agreement ◽

The Social ◽

The Impact

ABSTRACT Objectives: to analyze the impact of the Colombian Peace Agreement on the structural social determinants of health. Methods: a descriptive, ecological study, based on documentary data from 2008 to 2018. The records of victims, epidemiological indicators, and structural social determinants of health in Colombia were analyzed. Results: there was a correlation between the period in which the Peace Agreement process was developed and the indicators of structural determinants in health with p<0.05. With the Poisson regression analysis, the favorable correlations between the peace process and the determinants were confirmed, besides allowing the understanding of the changes in these indicators before the Peace Agreement. Conclusions: the implementation of the peace process has a positive impact on structural social determinants of health, which is observed by the beginning of the decrease of economic, educational, health, and social inequalities and inequities, a fact that offers the possibility of living in peace.

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