Engaging medical students and their teachers with the determinants of health: the approaches and impact of a curriculum development at one large UK medical school (Published 2014)
Apr 06, 2016
Wylie A, Leedham-Green K and Tadeka Y
Social determinants of health (‘SDH’) often underlie the health behaviours that contribute to non-communicable disease. This paper reports on the introduction of core curriculum modifications with explicit learning outcomes around SDH in one large medical school.
Background: Social determinants of health (‘SDH’) often underlie the health behaviours that contribute to non-communicable disease. Doctors need to be aware of health behaviours and their determinants and the evidence-based interventions to address them.
Aim: Co-ordinated core curriculum modifications were instigated with explicit learning outcomes in and around health promotion and SDH. This paper reports on the research evaluation of process and outcome and sustainability of these changes in one large medical school.
Method: Mixed method research data were used to inform an action research cycle. Data were analysed for content and emerging themes related to smoking cessation, obesity reduction, and global health were informed by SDH.
Results and analysis: Students demonstrated knowledge and concern relating to SDH, although some initially lacked confidence in applying this knowledge. Students reported inconsistent modelling clinical environments. Attention was given to the learning environment as well as teacher training to facilitate and support self-efficacy through reflection and critical analysis.
Conclusion: Newer medical education themes such as SDH need robust preparation for inclusion in core curricula, with attention to the social, cognitive and environmental impacts on learning. Teaching and experiential learning for SDH is now embedded in this curriculum.
I enjoyed reading this paper and felt that it addressed a very topical and important area of dealing with the Social Determinants of Health and the rising problem on how to deal with non-communicable disease. It describes in great detail an element of the curriculum map that places SDH firmly on such a map.
However, I feel that there are several elements of the paper I would not agree with. I do think that SDH and non-communicable diseases are taught in many curricula, it is that they are frequently not stand-alone activities and are more often taught through integration -however I do appreciate that in certain circumstances the clarity that this paper demonstrates is important for both faculty and students.
I do not think that the methods used are particularly innovative or new - many schools do have similar programmes, although again I appreciate that the evaluation supported the value as seen by the faculty ( GPs) and students
Of course the real value will be seen when these students progress into the real world and are exposed to the difficulties of turning the SDHs into real and effective activities.