Kirkland Jacob T, Berry Aiden, Beck Dallaghan Gary L, Moore Zach, Koonce Thomas F
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Medicine-Pediatrics, University of Michigan Medical Center, Ann Arbor, MI, USA.
Med Sci Educ. 2021 Aug 17;31(5):1685-1692. doi: 10.1007/s40670-021-01360-5. eCollection 2021 Oct.
Addressing health disparities is necessary to ensure appropriate care for patients. This study examined the impact of Clinical Week experiences on students' recognition of social determinants of health early in their medical education.
A 5-day experience each of the first three semesters of medical school provided direct patient care experiences. Two Clinical Weeks were spent in outpatient clinics located primarily in rural areas. Students completed a reflective writing assignment about their experiences after each 5-day experience. Ninety-two reflections during AY 2018-2019 included discussions about social determinants of health. Two investigators analyzed these essays independently using narrative inquiry techniques. After inductive coding was complete, researchers discussed themes and their broader meaning.
Themes emerged related to health disparities experienced by rural communities, minority populations, and both uninsured and underinsured patients. Reflections emphasized a lack of public accommodations in rural settings, such as public transportation and access to healthy food. Students noted how ethnic, cultural, and linguistic identity affect a patient's experience with healthcare. Other themes involved the challenges patients face affording treatment plans and conversely how health status can impact economic stability. Finally, students emphasized the importance of physician advocacy in overcoming such barriers to quality health care.
Although not the emphasis of Clinical Week, students' reflections identified critical social issues impacting the health of patients they encountered. This experience could be adapted at other institutions.
解决健康差异问题对于确保为患者提供适当的护理至关重要。本研究考察了临床周经历对医学生在医学教育早期对健康的社会决定因素的认知的影响。
医学院前三个学期各安排一次为期5天的体验，提供直接的患者护理体验。其中两个临床周安排在主要位于农村地区的门诊诊所。学生在每次5天的体验结束后完成一份关于他们经历的反思性写作作业。2018 - 2019学年的92篇反思文章包括了关于健康的社会决定因素的讨论。两名研究人员使用叙事探究技术独立分析这些文章。在归纳编码完成后，研究人员讨论了主题及其更广泛的意义。
出现了与农村社区、少数族裔人群以及未参保和参保不足的患者所经历的健康差异相关的主题。反思强调农村地区缺乏公共设施，如公共交通和获得健康食品的机会。学生们指出了种族、文化和语言身份如何影响患者的医疗体验。其他主题涉及患者在支付治疗方案方面面临的挑战，以及相反地健康状况如何影响经济稳定性。最后，学生们强调了医生在克服这些优质医疗障碍方面进行倡导的重要性。
尽管临床周并非重点，但学生的反思识别出了影响他们所接触患者健康的关键社会问题。这种体验可以在其他机构进行调整。
