M. Bann is assistant professor, Department of Medicine, University of Washington, Seattle, Washington; ORCID: https://orcid.org/0000-0002-5893-950X .
S. Larimore is a postdoctoral research associate, Department of Sociology, and a postdoctoral affiliate, Center for the Study of Race, Ethnicity & Equity, Washington University in St. Louis, St. Louis, Missouri.
Acad Med. 2022 Nov 1;97(11):1665-1672. doi: 10.1097/ACM.0000000000004804. Epub 2022 Jul 5.
Following shifts that broadened the medical profession's conceptualization of the underlying drivers of health, medical schools are required to integrate curricula on health disparities and the social context of medicine into undergraduate medical education. Although previous research has focused on student experiences and outcomes in these curricula, less attention has been paid to the experiences of the physician-faculty involved. This study aimed to capture faculty insights to improve understanding of the challenges and opportunities of implementing this curricular reform.
In-depth, semistructured interviews were conducted with 10 faculty members at one U.S. medical school in spring 2019 to capture their experiences designing and teaching a new curriculum related to the social determinants of health and health disparities. Study design, including interview guide development, was informed by the critical pedagogy perspective and social constructionist approaches to curriculum implementation. With the use of a constructivist grounded theory approach, interview transcripts were analyzed using open, thematic, and axial coding techniques. Primary themes were categorized as professional, organizational, interactional, or intrapersonal and organized into the final model.
Participants processed their experiences at 4 concentric levels: professional, organizational, interactional, and intrapersonal. Faculty generally embraced the movement to incorporate more discussion of social context as a driver of health outcomes. However, they struggled with the shortcomings of their training and navigating structural constraints within their school when developing and delivering content. When confronted with these limitations, faculty experienced unexpected tension in the classroom setting that catalyzed self-reflection and reconstruction of their teaching approach.
Findings highlight the challenges that faculty encounter when integrating social determinants of health and related curricula into undergraduate medical education. They also speak to the need for a broader conceptualization of relevant expertise and have implications for how medical schools select, train, and support medical educators in this work.
随着医学专业对健康潜在驱动因素的概念不断扩大，医学院校被要求将卫生差异和医学社会背景方面的课程纳入本科医学教育。尽管先前的研究侧重于学生在这些课程中的体验和成果，但对参与其中的医师教师的经验关注较少。本研究旨在了解教师的见解，以增进对实施这种课程改革的挑战和机遇的理解。
2019 年春季，我们对美国一所医学院的 10 名教师进行了深入的半结构化访谈，以了解他们在设计和教授与健康差异和健康决定因素相关的新课程方面的经验。研究设计包括访谈指南的制定，这是受批判教育学观点和社会建构主义课程实施方法的启发。采用建构主义扎根理论方法，使用开放式、主题式和轴向编码技术对访谈记录进行分析。主要主题分为专业、组织、互动和个人内部，并组织到最终模型中。
参与者在 4 个同心层次上处理他们的经验：专业、组织、互动和个人内部。教师普遍接受将更多关于社会背景作为健康结果驱动因素的讨论纳入的运动。然而，在开发和提供内容时，他们在培训和在学校内导航结构限制方面存在困难。当面对这些限制时，教师在课堂环境中经历了意想不到的紧张，这促使他们进行自我反思并重建教学方法。
研究结果突出了教师在将健康决定因素和相关课程纳入本科医学教育中所面临的挑战。它们还说明了需要更广泛地理解相关专业知识，并对医学院校在这项工作中选择、培训和支持医学教育者产生影响。
