Social Determinants of Health Learning Goals in Graduate Medical Education

05-06-2022 10:14

The Accreditation Council for Graduate Medical Education (ACGME) has called for specific residency training on healthcare disparities, but acknowledges that there is “a general lack of understanding both within the graduate medical education [GME] community and among the clinical leadership of the clinical learning environments as to what constitutes health care disparities in their patient populations.” A 2019 review of social determinants of health training in US primary care residency programs highlights the need for systematic, standardized approaches to developing and delivering SDH curricula along with rigorous evaluation, particularly on resident behavior.
Objective: Prioritize SDH learning goals in knowledge and behavior for primary care residency training using a Delphi consensus methodology.
Methods: Stage 1) Modified Delphi survey based on comprehensive literature review:
- Two published scoping reviews of SDH education in GME until 2017 [50 articles/abstracts]
- Additional review of literature using standardized search terms from 2017 until 2019 [47 articles/abstracts]
- Evidence-based frameworks, toolkits and position statements [28]
- Local Delphi working group compiled, refined via iterative group discussion, and piloted learning goals
2) National Delphi panelists who met criteria: published in GME and SDH, or lead courses/programs in SDH in GME, and in the fields of family medicine, internal medicine, Ob-Gyn and pediatrics - were recruited from national professional organizations and interest groups.
Panelists ranked learning goals on a 5-point Likert scale from "not at all important" to "extremely important": How important do you think this learning goal is for residency education?
• A priori consensus definition for agreement: >= 80 percent of participants ranked 4 or 5.
• Delphi survey stopped after responses remained stable between rounds
Results: 22 knowledge and 21 behavior learning goals reached consensus for inclusion after the second round.
Conclusions: (1) Knowledge of structural determinants of health, equity, racism, and domains of SDH achieved largest expert consensus.
Behaviors of communication about social needs, linguistic competency, eliciting social needs, advocating for patients, and engaging clinic resources achieved largest consensus.
This work sets the stage for systematic, standardized approaches to developing and delivering SDH curricula along with rigorous evaluation, particularly on resident behavior.

Author(s):Iman F. Hassan MD MS, Victoria Gorski MD, Dana Sanderson MD, Sandra Braganza MD MPH, Nerys Benfield MD MPH, Marisa Nadas MD MPH, Erka Amursi MA, Cristina M. Gonzalez MD MEd
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Results of a Delphi Study

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