Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, Chicago, IL, USA.
Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
BMC Med Educ. 2020 Jan 16;20(1):18. doi: 10.1186/s12909-020-1931-1.
Up to 60% of preventable mortality is attributable to social determinants of health (SDOH), yet training on SDOH competencies is not widely implemented in residency. The objective of this study was to assess internal and family medicine residents' competence at identifying and addressing SDOH.
Residents' perceived competence at identifying, discussing, and addressing SDOH in outpatient settings was assessed using a single questionnaire administered in March 2017. In this cross-sectional analysis, bivariate associations of resident characteristics with the following outcomes were examined: identifying, discussing, and addressing patients' challenges related to SDOH through referrals.
The survey was completed by 129 (84%) residents. Twenty residents (16%) reported an annual income of less than $50,000 during childhood. Overall, 108 residents (84%) reported previous SDOH training. Two-thirds had outpatient practices in Veterans Affairs or safety-net clinics. Thirty-nine (30%) intended to pursue a career in primary care. The following numbers of residents reported high levels of competence for performing these outcomes: identifying patients' challenges related to SDOH: 37 (29%); discussing them with patients: 18 (14%); and addressing these challenges through referrals to internal and external resources: 13 (10%) and 11 (9%), respectively. Factors associated with higher competence included older age, lower childhood household income, prior education about SDOH, primary practice site and intention to practice primary care.
Most residents had previous SDOH training, yet only a small proportion of residents reported being highly competent at identifying or addressing SDOH. Providing opportunities for practical training may be a key component in preparing medical residents to identify and address SDOH effectively in outpatient practice.
高达 60%的可预防死亡率归因于健康的社会决定因素（SDOH），但在住院医师培训中，SDOH 能力培训并未广泛实施。本研究的目的是评估内科和家庭医学住院医师识别和解决 SDOH 的能力。
使用 2017 年 3 月进行的单问卷评估居民在门诊环境中识别、讨论和解决 SDOH 的能力。在这项横断面分析中，研究了居民特征与以下结果之间的双变量关联：通过转介识别、讨论和解决患者与 SDOH 相关的挑战。
调查完成于 129 名（84%）住院医师。20 名（16%）居民报告在童年时期的年收入低于 50,000 美元。总体而言，108 名（84%）居民报告了之前的 SDOH 培训。三分之二的居民在退伍军人事务或安全网诊所开展门诊实践。39 名（30%）居民打算从事初级保健工作。以下居民报告了执行这些结果的高水平能力：识别与 SDOH 相关的患者挑战：37（29%）；与患者讨论：18（14%）；通过转介至内部和外部资源解决这些挑战：13（10%）和 11（9%）。与更高的能力相关的因素包括年龄较大、童年家庭收入较低、先前关于 SDOH 的教育、初级实践地点和从事初级保健工作的意愿。
大多数居民之前都接受过 SDOH 培训，但只有一小部分居民报告在识别或解决 SDOH 方面具有高度能力。提供实践培训的机会可能是培养住院医师在门诊实践中有效识别和解决 SDOH 的关键组成部分。
