Abstract
Background: In June 2018, the Accreditation Council for Graduate Medical Education (ACGME) revised the common program requirements and identified a core requirement “to understand the social determinants of health (SDH) of the populations they serve and incorporate them in the design and implementation of the program curriculum, with the ultimate goal of addressing these needs and health disparities.1” Trainees must “demonstrate an awareness of and responsiveness to the larger context and system of health care, including the SDH, as well as the ability to call effectively on other resources to provide optimal health care.” While Association of American Medical Colleges (AAMC) teaching hospitals comprise 5% of the total US hospitals, they provide 40% of charity care in the US. In this setting, trainees need to be aware of the challenges faced by the communities they serve. SDH are increasingly recognized for their importance in the care of patients with diabetes and explain the health disparities in diabetes that exist throughout the US. Endocrinology fellows and the faculty teaching them must therefore demonstrate knowledge of SDH and health disparities.
Methods: We investigated the knowledge gaps in SDH in an urban academic endocrinology fellowship. All fellows and faculty members completed a 10-question survey that assessed knowledge, confidence, and motivation to learn about SDH. Six fellows and 10 faculty members completed the survey.
Results: While 60% of faculty and 83% fellows reported having an understanding of SDH, no fellows or faculty could correctly identify all 6 SDH. When asked about their confidence level in identifying SDH, 20% of faculty had low confidence, 70% were confident, and 10% were very confident. For fellows, 50% reported low confidence, 33% were confident, and 17% were very confident. There was lower confidence level in fellows and faculty when addressing SDH—with half the faculty feeling not confident or only somewhat confident. Fellows had lower confidence levels with addressing SDH, with 83% reporting low confidence. However, motivation was high amongst fellows and faculty to learn more about SDH—83% of fellows and 70% of faculty were very motivated to learn more about SDH.
Conclusion: The ACGME has made knowledge of SDH a common program requirement of all training programs. A needs assessment of SDH in an urban endocrinology fellowship program identified knowledge and confidence gaps about SDH, but a high motivation to learn by both fellows and faculty. While trainees and faculty often learn “on the job” about SDH and health disparities, this study reveals that formal curricular activities must be incorporated into endocrinology fellowship programs to meet the ACGME common program requirements.
1.
ACGME “Common Program Requirements.” https://www.acgme.org/What-We-Do/Accreditation/Common-Program-Requirements.
Social Determinants of Health: Considerations for Athletic Health Care
