Haruta Junji, Takayashiki Ayumi, Ozone Sachiko, Maeno Takami, Maeno Tetsuhiro
Medical Education Center, School of Medicine, Keio University, Tokyo, Japan.
Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Japan.
Med Teach. 2022 Oct;44(10):1165-1172. doi: 10.1080/0142159X.2022.2072282. Epub 2022 May 18.
The need to learn social determinants of health (SDH) is increasing in disparate societies, but educational interventions are complex and learning mechanisms are unclear. Therefore, this study used a realist approach to identify SDH learning patterns, namely context (C), mechanism (M), and outcomes (O) in communities.
A 4-week clinical practice program was conducted for 5- and 6-year medical students in Japan. The program included SDH lectures and group activities to explore cases linked to SDH in the community. The medical students' structural reflection reports for learning SDH were thematically analyzed through CMO perspectives.
First, medical students anticipated the concept of SDH and participated in a community in which a social model was central. They then transformed their perspective through observational learning and explanations from role models. Second, medical students' confrontation of contradictions in the medical model triggered integrated explanations of solid facts. Third, conceptual understanding of SDH was deepened through comparison and verbalization of concrete experiences in multiple regions. Fourth, empathy for lay people was fostered by participating from a non-authoritative position, which differed from that in medical settings.
Medical students can learn about the connections between society and medicine through four types of SDH learning patterns.
在不同社会中，学习健康的社会决定因素（SDH）的需求日益增加，但教育干预措施复杂，学习机制尚不清楚。因此，本研究采用现实主义方法来确定社区中SDH的学习模式，即背景（C）、机制（M）和结果（O）。
为日本5年级和6年级的医学生开展了为期4周的临床实践项目。该项目包括SDH讲座和小组活动，以探讨社区中与SDH相关的案例。通过CMO视角对医学生学习SDH的结构性反思报告进行了主题分析。
首先，医学生预期了SDH的概念，并参与了一个以社会模式为核心的社区。然后，他们通过观察学习和榜样的解释转变了自己的观点。其次，医学生在医学模式中对矛盾的对抗引发了对确凿事实的综合解释。第三，通过对多个地区具体经历的比较和语言表达，深化了对SDH的概念理解。第四，通过以非权威的身份参与，培养了对非专业人士的同理心，这与医疗环境中的情况不同。
医学生可以通过四种SDH学习模式了解社会与医学之间的联系。
