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Social determinants of health (SDOH) are circumstances, such as living and work conditions, that affect patient health outcomes and contribute to health inequalities. Understanding patients’ SDOH can help physicians recognize barriers to care. Therefore, it is important that medical students learn to gather information on SDOH from patients.


Standardized patient (SP) encounters with rising third-year students were analyzed to determine if an educational intervention about SDOH increased the frequency SDOH were discussed with patients. SP encounters were randomly sampled from 2017 (pre-intervention, n1 = 37) and 2018 (post-intervention, n2 = 40) video recordings of students eliciting a new patient history in a primary care setting. Discussions regarding SDOH categories were coded by question type (yes/no versus open-ended) and the language used by the student.


The post-intervention cohort more frequently discussed all SDOH topics during their encounters except discrimination (0% for both years). However, housing, mental health, and employment were the only SDOH categories discussed more than 50% of the time for either cohort. On average, students in the post-intervention cohort asked more open-ended questions rather than yes/no questions when discussing SDOH. Open-ended questions allowed patients to give more details and sparked further conversation than yes/no questions.


The SDOH training intervention increased the frequency that most SDOH were discussed in patient encounters, but these data suggest there are still opportunities for more students to routinely elicit this information from patients. SDOH and open-ended questioning skills can be emphasized in medical education to help address health inequalities.

Publication Date

Spring 2021


Medical education; standard determinants of health; health inequities; MERA


Medical Education

Efficacy of a Social Determinants of Health Training Intervention