Kala Shashwat, Johnson Rachel, Phatak Uma, Fenick Ada, Goldman Michael
Yale School of Medicine, New Haven, Connecticut, USA.
Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA.
J Med Educ Curric Dev. 2025 May 30;12:23821205251342079. doi: 10.1177/23821205251342079. eCollection 2025 Jan-Dec.
The relationship between social determinants of health (SDH) and negative health outcomes is well established, prompting undergraduate medical educators to teach students to recognize and address these SDH. However, current SDH resources like the Healthy People 2030 report and published curricula lack a targeted approach to best teach and learn pediatric-specific SDH.
To use medical students' experiences working with patients affected by SDH on their pediatric clerkship as a targeted needs-assessment to drive pediatric-specific SDH curricula.
Qualitative analysis of the reflective journal entries of 94 medical students who rotated on the pediatrics clerkship from 2022-2023. Each student completed an entry on their experiences with pediatric SDH including identification of the SDH, perceptions of the impact of the SDH, and observed SDH navigation strategies. A team of three coders employed both deductive and inductive content analysis to the dataset. SDH codes were tabulated for frequency analysis.
Across the 94 entries, there were 205 reported SDH, with an average of 2.18 SDH per entry. Inductive content analysis resulted in six new pediatric-specific SDH in addition to those established by Healthy People 2030 report. Our analyses showed that students perceived SDH to impact pediatric patients and their families through five mechanisms; analyses of student entries also identified five strategies that the healthcare team used to facilitate SDH navigation. Finally, a frequency analysis showed that the three most common SDH clerkship students experienced were Language & literacy, Foster care / Department of Children and Families (DCF) system, and Insurance status.
Utilizing the medical student experience with SDH on the pediatric service can serve as a meaningful needs-assessment to drive pediatric-specific SDH curricular development. We identified a unique set of pediatric-specific SDH that may improve medical schools' SDH curricula.
健康的社会决定因素（SDH）与负面健康结果之间的关系已得到充分确立，这促使本科医学教育工作者教导学生认识并应对这些SDH。然而，当前的SDH资源，如《健康人民2030》报告和已发表的课程，缺乏一种有针对性的方法来最好地教授和学习儿科特定的SDH。
利用医学生在儿科实习期间与受SDH影响的患者合作的经历，作为有针对性的需求评估，以推动儿科特定的SDH课程。
对2022年至2023年在儿科实习轮转的94名医学生的反思日志条目进行定性分析。每名学生就其儿科SDH经历完成一篇日志，包括SDH的识别、对SDH影响的认知以及观察到的SDH应对策略。由三名编码员组成的团队对数据集采用了演绎和归纳内容分析。对SDH代码进行列表以进行频率分析。
在94篇日志条目中，共报告了205个SDH，平均每篇日志条目有2.18个SDH。归纳内容分析除了得出《健康人民2030》报告确定的SDH外，还产生了六个新的儿科特定SDH。我们的分析表明，学生认为SDH通过五种机制影响儿科患者及其家庭；对学生日志条目的分析还确定了医疗团队用于促进SDH应对的五种策略。最后，频率分析表明，医学生在实习中遇到的三个最常见的SDH是语言与读写能力、寄养/儿童与家庭部（DCF）系统以及保险状况。
利用医学生在儿科服务中与SDH相关的经历，可以作为有意义的需求评估，以推动儿科特定的SDH课程开发。我们确定了一组独特的儿科特定SDH，这可能会改进医学院校的SDH课程。
