Identifying and addressing social determinants of health in outpatient practice: Results of a program-wide survey of internal and family medicine residents

Lauren A. Gard; Andrew J. Cooper; Quentin Youmans; Aashish Didwania; Stephen D. Persell; Muriel Jean-Jacques; Paul Ravenna; Mita Sanghavi Goel; Matthew J. O'Brien

doi:10.1186/s12909-020-1931-1

Identifying and addressing social determinants of health in outpatient practice: Results of a program-wide survey of internal and family medicine residents

Lauren A. Gard, Andrew J. Cooper, Quentin Youmans, Aashish Didwania, Stephen D. Persell, Muriel Jean-Jacques, Paul Ravenna, Mita Sanghavi Goel, Matthew J. O'Brien

Research output: Contribution to journal › Review article › peer-review

21 Scopus citations

Abstract

Background: Up to 60% of preventable mortality is attributable to social determinants of health (SDOH), yet training on SDOH competencies is not widely implemented in residency. The objective of this study was to assess internal and family medicine residents' competence at identifying and addressing SDOH. Methods: Residents' perceived competence at identifying, discussing, and addressing SDOH in outpatient settings was assessed using a single questionnaire administered in March 2017. In this cross-sectional analysis, bivariate associations of resident characteristics with the following outcomes were examined: identifying, discussing, and addressing patients' challenges related to SDOH through referrals. Results: The survey was completed by 129 (84%) residents. Twenty residents (16%) reported an annual income of less than $50,000 during childhood. Overall, 108 residents (84%) reported previous SDOH training. Two-Thirds had outpatient practices in Veterans Affairs or safety-net clinics. Thirty-nine (30%) intended to pursue a career in primary care. The following numbers of residents reported high levels of competence for performing these outcomes: identifying patients' challenges related to SDOH: 37 (29%); discussing them with patients: 18 (14%); and addressing these challenges through referrals to internal and external resources: 13 (10%) and 11 (9%), respectively. Factors associated with higher competence included older age, lower childhood household income, prior education about SDOH, primary practice site and intention to practice primary care. Conclusions: Most residents had previous SDOH training, yet only a small proportion of residents reported being highly competent at identifying or addressing SDOH. Providing opportunities for practical training may be a key component in preparing medical residents to identify and address SDOH effectively in outpatient practice.

Original language	English (US)
Article number	18
Journal	BMC medical education
Volume	20
Issue number	1
DOIs	https://doi.org/10.1186/s12909-020-1931-1
State	Published - Jan 16 2020

Funding

This project is supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services (HHS) under grant number UH1HP29963, Academic Units for Primary Care Training and Enhancement. The funder had no role in the study design, the collection, analysis and interpretation of data and in writing the manuscript. REDCap is supported at FSM by the Northwestern University Clinical and Translational Science (NUCATS) Institute. Research reported in this publication was supported, in part, by the National Institutes of Health’s National Center for Advancing Translational Sciences, Grant Number UL1TR001422.

Keywords

Graduate medical education
Primary care
Social determinants of health

ASJC Scopus subject areas

Education

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s12909-020-1931-1

Cite this

Gard, L. A., Cooper, A. J., Youmans, Q., Didwania, A., Persell, S. D., Jean-Jacques, M., Ravenna, P., Goel, M. S., & O'Brien, M. J. (2020). Identifying and addressing social determinants of health in outpatient practice: Results of a program-wide survey of internal and family medicine residents. BMC medical education, 20(1), Article 18. https://doi.org/10.1186/s12909-020-1931-1

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title = "Identifying and addressing social determinants of health in outpatient practice: Results of a program-wide survey of internal and family medicine residents",

abstract = "Background: Up to 60% of preventable mortality is attributable to social determinants of health (SDOH), yet training on SDOH competencies is not widely implemented in residency. The objective of this study was to assess internal and family medicine residents' competence at identifying and addressing SDOH. Methods: Residents' perceived competence at identifying, discussing, and addressing SDOH in outpatient settings was assessed using a single questionnaire administered in March 2017. In this cross-sectional analysis, bivariate associations of resident characteristics with the following outcomes were examined: identifying, discussing, and addressing patients' challenges related to SDOH through referrals. Results: The survey was completed by 129 (84%) residents. Twenty residents (16%) reported an annual income of less than $50,000 during childhood. Overall, 108 residents (84%) reported previous SDOH training. Two-Thirds had outpatient practices in Veterans Affairs or safety-net clinics. Thirty-nine (30%) intended to pursue a career in primary care. The following numbers of residents reported high levels of competence for performing these outcomes: identifying patients' challenges related to SDOH: 37 (29%); discussing them with patients: 18 (14%); and addressing these challenges through referrals to internal and external resources: 13 (10%) and 11 (9%), respectively. Factors associated with higher competence included older age, lower childhood household income, prior education about SDOH, primary practice site and intention to practice primary care. Conclusions: Most residents had previous SDOH training, yet only a small proportion of residents reported being highly competent at identifying or addressing SDOH. Providing opportunities for practical training may be a key component in preparing medical residents to identify and address SDOH effectively in outpatient practice.",

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T2 - Results of a program-wide survey of internal and family medicine residents

AU - Gard, Lauren A.

AU - Cooper, Andrew J.

AU - Youmans, Quentin

AU - Didwania, Aashish

AU - Persell, Stephen D.

AU - Jean-Jacques, Muriel

AU - Ravenna, Paul

AU - Goel, Mita Sanghavi

AU - O'Brien, Matthew J.

PY - 2020/1/16

Y1 - 2020/1/16

N2 - Background: Up to 60% of preventable mortality is attributable to social determinants of health (SDOH), yet training on SDOH competencies is not widely implemented in residency. The objective of this study was to assess internal and family medicine residents' competence at identifying and addressing SDOH. Methods: Residents' perceived competence at identifying, discussing, and addressing SDOH in outpatient settings was assessed using a single questionnaire administered in March 2017. In this cross-sectional analysis, bivariate associations of resident characteristics with the following outcomes were examined: identifying, discussing, and addressing patients' challenges related to SDOH through referrals. Results: The survey was completed by 129 (84%) residents. Twenty residents (16%) reported an annual income of less than $50,000 during childhood. Overall, 108 residents (84%) reported previous SDOH training. Two-Thirds had outpatient practices in Veterans Affairs or safety-net clinics. Thirty-nine (30%) intended to pursue a career in primary care. The following numbers of residents reported high levels of competence for performing these outcomes: identifying patients' challenges related to SDOH: 37 (29%); discussing them with patients: 18 (14%); and addressing these challenges through referrals to internal and external resources: 13 (10%) and 11 (9%), respectively. Factors associated with higher competence included older age, lower childhood household income, prior education about SDOH, primary practice site and intention to practice primary care. Conclusions: Most residents had previous SDOH training, yet only a small proportion of residents reported being highly competent at identifying or addressing SDOH. Providing opportunities for practical training may be a key component in preparing medical residents to identify and address SDOH effectively in outpatient practice.

AB - Background: Up to 60% of preventable mortality is attributable to social determinants of health (SDOH), yet training on SDOH competencies is not widely implemented in residency. The objective of this study was to assess internal and family medicine residents' competence at identifying and addressing SDOH. Methods: Residents' perceived competence at identifying, discussing, and addressing SDOH in outpatient settings was assessed using a single questionnaire administered in March 2017. In this cross-sectional analysis, bivariate associations of resident characteristics with the following outcomes were examined: identifying, discussing, and addressing patients' challenges related to SDOH through referrals. Results: The survey was completed by 129 (84%) residents. Twenty residents (16%) reported an annual income of less than $50,000 during childhood. Overall, 108 residents (84%) reported previous SDOH training. Two-Thirds had outpatient practices in Veterans Affairs or safety-net clinics. Thirty-nine (30%) intended to pursue a career in primary care. The following numbers of residents reported high levels of competence for performing these outcomes: identifying patients' challenges related to SDOH: 37 (29%); discussing them with patients: 18 (14%); and addressing these challenges through referrals to internal and external resources: 13 (10%) and 11 (9%), respectively. Factors associated with higher competence included older age, lower childhood household income, prior education about SDOH, primary practice site and intention to practice primary care. Conclusions: Most residents had previous SDOH training, yet only a small proportion of residents reported being highly competent at identifying or addressing SDOH. Providing opportunities for practical training may be a key component in preparing medical residents to identify and address SDOH effectively in outpatient practice.

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KW - Primary care

KW - Social determinants of health

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Identifying and addressing social determinants of health in outpatient practice: Results of a program-wide survey of internal and family medicine residents

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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