Departments of Pediatrics, Medical Education, and Preventive Medicine, Feinberg School of Medicine, Northwestern University; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Research Project Manager, Patrick M. Magoon Institute for Healthy Communities, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, Chicago.
Med Educ Online. 2023 Dec;28(1):2178979. doi: 10.1080/10872981.2023.2178979.
Addressing the Social and Structural Determinants of Health (SSDH) is a primary strategy for attaining health equity. Teaching and learning about SSDH has increased across medical schools throughout the world; however, the published literature describing these efforts continues to be limited and many unknowns persist including what should be taught and by whom, what teaching methods and settings should be used, and how medical learners should be assessed.
Based on published studies, input from experts in the field, and elements from the framework developed by the National Academy of Medicine, we created a universal Social and Structural Determinants of Health Curriculum Assessment Tool (SSDH CAT) to assist medical educators to assess existing SSDH curricular content, ascertain critical gaps, and categorize educational methods, delivery, and assessment techniques and tools that could help inform curricular enhancements to advance the goal of training a health care workforce focused on taking action to achieve health equity. To test the usefulness of the tool, we applied the SSDH CAT to map SSDH-related curriculum at a US-based medical school.
By applying the SSDH CAT to our undergraduate medical school curriculum, we recognized that our SSDH curriculum relied too heavily on lectures, emphasized knowledge without sufficient skill building, and lacked objective assessment measures. As a result of our curricular review, we added more skill-based activities such as using evidence-based tools for screening patients for social needs, and created and implemented a universal, longitudinal, experiential community health curriculum.
We created a universal SSDH CAT and applied it to assess and improve our medical school's SSDH curriculum. The SSDH CAT provides a starting point for other medical schools to assess their SSDH content as a strategy to improve teaching and learning about health equity, and to inspire students to act on the SSDH.
解决健康的社会决定因素和结构性决定因素（SSDH）是实现健康公平的主要策略。全世界的医学院都在增加关于 SSDH 的教学和学习；然而，描述这些努力的已发表文献仍然有限，许多未知因素仍然存在，包括应该教授什么以及由谁教授、应该使用什么教学方法和设置，以及应该如何评估医学生。
基于已发表的研究、该领域专家的意见以及国家医学院制定的框架的要素，我们创建了一个通用的社会和结构性决定因素健康课程评估工具（SSDH CAT），以帮助医学教育工作者评估现有的 SSDH 课程内容，确定关键差距，并对教育方法、交付以及评估技术和工具进行分类，这些都有助于为课程的改进提供信息，以推进培养关注采取行动实现健康公平的医疗保健劳动力的目标。为了测试该工具的有用性，我们将 SSDH CAT 应用于美国一所医学院的 SSDH 相关课程。
通过将 SSDH CAT 应用于我们的本科医学课程，我们认识到我们的 SSDH 课程过于依赖讲座，强调知识而没有足够的技能培养，并且缺乏客观的评估措施。作为课程审查的结果，我们增加了更多基于技能的活动，例如使用循证工具对患者进行社会需求筛查，并创建和实施了一个通用的、纵向的、体验式的社区健康课程。
我们创建了一个通用的 SSDH CAT，并将其应用于评估和改进我们医学院的 SSDH 课程。SSDH CAT 为其他医学院提供了一个评估其 SSDH 内容的起点，作为改善健康公平教学和学习的策略，并激励学生在 SSDH 方面采取行动。
