Background: A patient’s hospitalization encounter is a valuable opportunity to align potential social and structural barriers with the healthcare multidisciplinary team’s (MDT) resources for intervention. Teaching learners to assess and address social determinants of health (SDH) is a key objective of medical education and becoming a physician. Few studies describe curricula implementing these skills during clerkships, and no studies describe a strategy that may apply across different inpatient experiences. Assessment of the learning climate at this institution showed inequity in clerkship student experience, thus motivating the creation of innovative curricula to promote equity.
Purpose: To equip learners with a structured framework to assess and incorporate valuable SDH patient information during inpatient encounters, thus empowering them to advocate at a patient level for better outcomes.
Description: At an academic, urban institution, we created an experiential “Health Equity Bundle” curriculum, HEBC, initially piloted in 2019 for students on their internal medicine (IM) clerkship. Based on its success, psychiatry (P) and neurology (N) clerkship leaders sought to expand HEBC to their inpatient sites. IM hospitalists championed this and launched it to this 3-clerkship block in January 2023. At the onset of their IM-P-N block, students attended a virtual HEBC workshop of didactics and small group breakouts. We taught a framework on how to sensitively interview hospitalized patients about their SDH, and we described six major SDH domains (Table 1). Students practiced how to frame and ask questions addressing each domain, then ways to document and present this information to their medical teams within a structured “health equity bundle” (HEB) at the end of their notes. We introduced ways to address barriers related to SDH and advocate for inpatients, including examples of resources and collaboration with MDT. They were expected to implement this with one or more patient each month during their inpatient time. Midway through the block, they attended a virtual debrief session where they shared their experiences and learned from peers in small breakout groups and a large group. Students were asked to write a 1-2 paragraph reflection on this HEBC experience.We performed a thematic analysis of student reflections (n=160) collected between January – October 2023 (3 IM-P-N blocks) through an inductive approach. Two authors independently then collectively identified 5 major themes with subthemes (Table 2). Early analysis of a subset of reflections suggests the most prominent subthemes are: experiencing increased insight, HEB leading to greater awareness of SDH, and HEB leading to providing assistance for SDH barriers.
Conclusions: We successfully launched a multi-inpatient site and specialty curriculum focused on health equity for patients, with learner reflections emphasizing the value of using a structured framework to identify and impact SDH during inpatient clerkship rotations. Specifically, having a structured framework allowed learners to more effectively identify and address SDH, form deeper relationships with their patients, collaborate meaningfully with the MDT and be more aware of the true impact of structural health inequities. The success of HEBC across diverse sites suggests broad applicability to a variety of hospitalist teaching sites and various levels of learners.
