Curriculum Takes Aim at Social Determinants of Health

A young blonde woman in blue scrubs administers a vaccine shot to an elderly African American man in an outdoor setting

Wake Forest School of Medicine faculty and students are helping to prove the value of including health equity in the medical curriculum to address social determinants of health (SDH).

There is a growing recognition that social factors, such as racial bias, access to care and housing and food insecurity, have a significant impact on people’s health. Compounding and amplifying those underlying inequalities are the ongoing disruptions related to the COVID-19 pandemic and social unrest in our country.

Although the National Academy of Medicine, American College of Physicians, American Academy of Pediatrics and other organizations currently recommend that screening for SDH be included in clinical care, medical education has lagged behind in teaching students how to recognize and address these disparities with patients.

However, in a study published in March in the Journal of the American Medical Association Network Open, doctors at the School of Medicine found that incorporating a health equity curriculum was associated with a significant improvement in students’ knowledge and understanding of SDH and their confidence in working with underserved populations.

MD Class of 2023 students Collette O’Connor, Yaw Kumi-Ansu, Kishan Patel and Christopher Ma volunteer with H.O.P.E. (Help Our People Eat)
“Our goal was to better prepare our future doctors to recognize the social and economic factors that affect health and to think about new ways to help their future patients with these issues,” said the study’s corresponding author, Deepak Palakshappa, MD, assistant professor of internal medicine and pediatrics.

“We wanted to offer it as part of our third-year training when medical students start seeing patients, rather than in the first- or second-year classroom setting like other medical schools that offer social equity curriculums.”

The school’s team, led by Nancy Denizard-Thompson, MD ’02, associate professor of internal medicine, developed and implemented the longitudinal health equity curriculum for third-year medical students at the school in 2018. Simultaneously, they began a study, supported by a grant from the Fullerton Foundation, to evaluate the effectiveness of the curriculum on students’ self-reported knowledge of SDH and their confidence in working with underserved populations.

The curriculum consisted of health equity simulations, a series of online modules presenting available scientific data on the issues, and experiential learning through partnerships with community-based organizations in the city. For example, medical students would spend a day going out to help deliver food with Help Our People Eat (H.O.P.E.), a local group focused on access to food in low-income neighborhoods, Palakshappa said.

Two young men and two young women, all wearing face masks, stand outside a Samaritan Ministries building

To evaluate the effectiveness of the new curriculum, the 314 third-year medical students in the classes of 2019 and 2020 were surveyed at baseline, at the end of third year and at graduation. The class of 2018, which did not participate in the curriculum, served as the control group.

Total self-reported knowledge and confidence scores increased between baseline and end of the third year of medical school by eight points based on a standard measuring method. Total scores at graduation remained higher by eight points for those who participated in the new program versus the control group.

“Ideally this experience will stay with students through residency and beyond, and hopefully they will begin incorporating screening for social determinants when they begin their practices,” Palakshappa said.

Based on this research, the curriculum is now mandatory for all third-year MD program Wake Forest medical students.