专家共识：将健康的社会决定因素纳入本科医学教育课程。

Expert Consensus on Inclusion of the Social Determinants of Health in Undergraduate Medical Education Curricula.

机构信息

K.A. Mangold is assistant professor, Departments of Pediatrics and Medical Education, Feinberg School of Medicine, Northwestern University, and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. T.R. Bartell is research project manager, Mary Ann and J. Milburn Smith Child Health Research, Outreach and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. A.A. Doobay-Persaud is assistant professor, Division of Hospital Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. M.D. Adler is professor, Departments of Pediatrics and Medical Education, Feinberg School of Medicine, Northwestern University, and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. K.M. Sheehan is professor, Departments of Pediatrics and Preventive Medicine, Feinberg School of Medicine, Northwestern University, and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.

出版信息

Acad Med. 2019 Sep;94(9):1355-1360. doi: 10.1097/ACM.0000000000002593.

DOI:10.1097/ACM.0000000000002593

PMID:31460933

Abstract

PURPOSE

Accreditation bodies have mandated teaching social determinants of health (SDH) to medical students, but there has been limited guidance for educators on what or how to teach, and how to evaluate students' competence. To fill this gap, this study aimed to develop an SDH curricular consensus guide for teaching SDH to medical students.

METHOD

In 2017, the authors used a modified Delphi technique to survey an expert panel of educators, researchers, students, and community advocates about knowledge, skills, and attitudes (KSA) and logistics regarding SDH teaching and assessment. They identified the panel and ranked a comprehensive list of topics based on a scoping review of SDH education studies and discussions with key informants. A total of 57 experts were invited.

RESULTS

Twenty-two and 12 panelists participated in Delphi rounds 1 and 2, respectively. The highest-ranked items regarding KSA were "Appreciation that the SDH are some of the root causes of health outcomes and health inequities" and "How to work effectively with community health workers." The panel achieved consensus that SDH should constitute 29% of the total curriculum and be taught continuously throughout the curriculum. Multiple-choice tests were ranked lowest as an assessment method, and patient feedback was ranked highest. Panelists noted that SDH content must be a part of standardized exams to be prioritized by faculty and students.

CONCLUSIONS

An expert panel endorsed essential curricular content, teaching methods, and evaluation approaches that can be used to help guide medical educators regarding SDH curriculum development.

摘要

目的

认证机构已要求医学学生学习社会决定健康因素（SDH），但教育工作者在教授内容、方法以及评估学生能力方面缺乏指导。为弥补这一空白，本研究旨在制定一个医学学生 SDH 教学课程共识指南。

方法

2017 年，作者采用改良 Delphi 技术，就 SDH 教学和评估方面的知识、技能和态度（KSA）以及后勤问题，向教育工作者、研究人员、学生和社区倡导者的专家小组进行了调查。他们根据 SDH 教育研究的范围综述以及与主要知情人的讨论，确定了小组成员，并对一个全面的主题清单进行了排名。共邀请了 57 名专家。

结果

分别有 22 名和 12 名小组成员参加了 Delphi 第 1 轮和第 2 轮。KSA 方面排名最高的项目是“认识到 SDH 是健康结果和健康不公平的一些根本原因”和“如何与社区卫生工作者有效合作”。专家组就 SDH 应占总课程的 29%以及应在整个课程中持续教授达成了共识。多项选择题被评为评估方法中最低的，而患者反馈则被评为最高的。小组成员指出，SDH 内容必须成为标准化考试的一部分，才能得到教师和学生的重视。