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Abstract

Introduction

Social determinants of health (SDOH)—the conditions in which people live, learn, and work—play a vital, but often neglected role in shaping a community’s health. SDOH influence risk factors for disease and access to healthcare, consequently promoting health inequities among different populations. Examining how providers discuss SDOH with patients can identify opportunities to better integrate social context into care.

Methods

We analyzed standardized patient (SP) encounters of rising UofL M3 trainees to 1) determine whether SDOH are integrated into healthcare conversations, and 2) investigate what constitutes an authentic conversation to identify how trainees can better express interest in a patient. SP encounters (n=41) were randomly sampled from 139 video recordings of new patient histories. Discussions concerning SDOH categories were coded for content, patient response, and the perceived authenticity of each interaction.

Results

The most frequently discussed SDOH was employment (80.49% of encounters) while financial security (0%), healthcare access (2.44%), and discrimination (2.44%) were among the least discussed. Trainees appeared more engaged and interested when they empathized with patients, provided reassurance, established personal connections, and displayed a logical/organized flow of thought.

Discussion

Clinical skills around SDOH could be improved if students were provided more practice incorporating patients’ answers about SDOH into the health management plan. SDOH discussions can be used to get to know the patient holistically and foster strong doctor-patient relationships, both of which are crucial communication/clinical skills assessed by licensing exams. Emphasis on SDOH in medical education can help students advance these skills.

Publication Date

2020

Keywords

Social Determinant of Health, Social Determinants of Health, Medical Education, Clinical Skills

Disciplines

Education | Medicine and Health Sciences

Frequency and Perceived Authenticity of Social Determinants of Health Discussion by Medical Trainees

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