Emergency Medicine Residency Program, Highland Hospital, Oakland, California, USA
Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Postgrad Med J. 2022 Feb;98(1156):79-85. doi: 10.1136/postgradmedj-2020-138914. Epub 2020 Dec 7.
Social and economic factors have a profound impact on patient health. However, education about these factors has been inconsistently incorporated into residency training. Neighbourhood walking tours may help physician-residents learn about the social determinants of health (SDoH). We assessed the impact of a neighbourhood walking tour on physician-residents' perceptions of SDoH, plans for counselling patients and knowledge of community resources. Using a community-based participatory research approach, in 2017 we implemented a neighbourhood walking tour curriculum for physician-residents in internal medicine, internal medicine/primary care, emergency medicine, paediatrics, combined internal medicine/paediatrics and obstetrics/gynaecology. In both pre-tour and post-tour, we asked participants to (1) rank the importance of individual-level and neighbourhood-level factors affecting patients' health, (2) describe strategies used to improve health behaviours and (3) describe knowledge of community resources. Eighty-one physician-residents participated in walks (pre-tour surveys (93% participation rate (n=75)), and post-tour surveys (53% participation rate (n=43)). Pre-tour, the factor ranked most frequently affecting patient health was 'access to primary care' (67%) compared with post-tour: 'income' (44%) and 'transportation' (44%). In describing ways to improve diet and exercise, among pre-tour survey respondents, 67% discussed individual-level strategies and 16% discussed neighbourhood-level, while among post-tour survey respondents, 39% of respondents discussed individual-level strategies and 37% discussed neighbourhood-level. Percentage of respondents aware of community resources changed from 5% to 76% (p<0.001). Walking tours helped physician-residents recognise the importance of SDoH and the value of community resources, and may have broadened frameworks for counselling patients on healthy lifestyles.
社会和经济因素对患者的健康有着深远的影响。然而，这些因素的教育在住院医师培训中一直没有得到一致的纳入。邻里步行游览可以帮助医生住院医师了解健康的社会决定因素（SDoH）。我们评估了邻里步行游览对医生住院医师对 SDoH 的认知、对患者咨询的计划和对社区资源的了解的影响。我们采用基于社区的参与式研究方法，在 2017 年为内科、内科/初级保健、急诊医学、儿科、内科/儿科和妇产科的医生住院医师实施了邻里步行游览课程。在游览前和游览后，我们要求参与者：（1）对影响患者健康的个人和邻里因素的重要性进行排名；（2）描述改善健康行为的策略；（3）描述对社区资源的了解。共有 81 名医生住院医师参加了步行游览（游览前调查（参与率为 93%（n=75））和游览后调查（参与率为 53%（n=43））。在游览前，排名最频繁影响患者健康的因素是“获得初级保健”（67%），而在游览后，排名前四的因素是“收入”（44%）和“交通”（44%）。在描述改善饮食和运动的方法时，在游览前调查的受访者中，67%讨论了个人层面的策略，16%讨论了邻里层面的策略，而在游览后调查的受访者中，39%的受访者讨论了个人层面的策略，37%讨论了邻里层面的策略。知道社区资源的受访者比例从 5%上升到 76%（p<0.001）。步行游览帮助医生住院医师认识到 SDoH 的重要性和社区资源的价值，并且可能拓宽了为患者提供健康生活方式咨询的框架。
