Siegel Jennifer, Coleman David L, James Thea
J. Siegel is assistant professor of medicine, Boston University School of Medicine, and associate program director, Boston Medical Center Internal Medicine Residency Program, Boston, Massachusetts. D.L. Coleman is Wade Professor of Medicine and chair, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts. T. James is associate professor of emergency medicine, Boston University School of Medicine, and vice president of mission, Boston Medical Center, Boston, Massachusetts.
Acad Med. 2018 Feb;93(2):159-162. doi: 10.1097/ACM.0000000000002054.
Social determinants of health (SDH) are the major drivers of health and disparate health outcomes across communities and populations. Given this, the authors assert that competency in recognizing and mitigating SDH should become a vital component of graduate medical education in all specialties. Although the most effective approaches to educating trainees about SDH are uncertain, in this Invited Commentary, the authors offer several key principles for implementing curricula focusing on SDH. These include universalization of the material, integration into clinical education, identification of space for trainee introspection, clarification of specific competencies in identification and mitigation of SDH, and creation of robust faculty development programming. The authors highlight several examples of curricular approaches to SDH, touching on orientation, experiential learning, community-based and service-learning opportunities, interprofessional activities, and the hidden curriculum. The authors argue that all clinical trainees must learn to recognize and mitigate SDH and that doing so will allow them to achieve meaning and mastery in medicine and to better meet society's pressing health needs.
健康的社会决定因素（SDH）是不同社区和人群健康状况及健康结果差异的主要驱动因素。鉴于此，作者断言，识别和减轻健康的社会决定因素的能力应成为所有专业研究生医学教育的重要组成部分。尽管向学员传授健康的社会决定因素的最有效方法尚不确定，但在这篇特邀评论中，作者提供了实施关注健康的社会决定因素课程的几个关键原则。这些原则包括材料的普及、融入临床教育、确定学员自我反思的空间、明确识别和减轻健康的社会决定因素的具体能力，以及创建强大的教师发展计划。作者强调了一些针对健康的社会决定因素的课程方法示例，涉及入职培训、体验式学习、基于社区和服务学习的机会、跨专业活动以及隐性课程。作者认为，所有临床学员都必须学会识别和减轻健康的社会决定因素，这样做将使他们在医学中获得意义和掌控力，并更好地满足社会紧迫的健康需求。
