Inside Wake Forest’s Health Equity, SDOH Medical School Program

A new health equity curriculum at Wake Forest School of Medicine helped improve self-reported knowledge about social determinants of health, a metric school leaders say could prepare new doctors in value-based care.

The curriculum, detailed in a recent JAMA Network Open article, improved knowledge about social determinants of health by about eight points on a 32-point scale.

These findings come as the healthcare industry increasingly focuses on health equity and the social determinants of health that can stymie that equity. Most experts agree on an ideal for total health equity, and that efforts to address social determinants of health are the path toward that ideal.

However, incorporating SDOH and screenings into medical delivery is still a burgeoning field. Clinicians are responsible for a lot during a healthcare encounter, and these screenings are still not fully developed.

“Thus, it is imperative that medical schools increase commitment and investment in teaching students about SDH and health equity, and medical school education can have an influence in reducing health disparities,” the researchers said. “Prior studies have found that students who attend medical schools that include health equity curricula are more likely to practice in underserved communities.”

These types of health equity curricula aren’t entirely unheard of, the researchers said, but they usually are one-off approaches that happen inside the classroom. The Wake Forest Medical School curriculum attempted to break that mold by designing an experiential curriculum.

“Our goal was to better prepare our future doctors to recognize the social and economic factors that affect health and to think about new ways to help their future patients with these issues,” the study’s corresponding author, Deepak Palakshappa, MD, assistant professor of internal medicine and pediatrics at Wake Forest School of Medicine, part of Wake Forest Baptist Health, said in a statement.

“We wanted to offer it as part of our third-year training when medical students start seeing patients, rather than in the first- or second-year classroom setting like other medical schools that offer social equity curriculums.”

Wake Forest’s health equity curriculum included some didactic training as well as key in-person learning opportunities. Students visited community health partners, such as Help Our People Eat (HOPE), which helps address food insecurity in the area.

The researchers implemented the curriculum in 2018, and tested its efficacy on the classes of 2019 and 2020. Those students were surveyed for self-reported knowledge about social determinants of health at the end of their third year of medical school and at graduation. The class of 2018, which did not complete the training, served as a control group.

Self-reported knowledge about social determinants of health improved by about a third, increasing eight points on the 32-point scale, the researchers reported. Notably, those gains sustained over a year, underscoring how effective the longitudinal educational approach was on imparting a lasting lesson.

Central to the approach was student work with community health partners, the researchers said. This part of the curriculum was broadly seen as the most meaningful from students.

“The community experiences were also a chance for many students to connect the dots,” the research team observed. “In required reflection pieces, students discussed seeing the same patients who they cared for in the emergency department or the hospital visiting the soup kitchen where the students worked later that day.”

The researchers recommended other medical school leaders consider incorporating such an approach into their own curricula.

The researchers did some work to add to the curriculum, but additional modules proved ineffective at boosting student confidence and knowledge levels. This could indicate that a more limited number of modules is effective, that other shifts in medical school curricula had an impact, or that survey questions did not capture the full impact of the expanded curriculum.

That said, Wake Forest leaders asserted the health equity training will be a permanent fixture in third-year education. This will be essential as the healthcare industry continues to embrace value-based care and strive for health equity.

“Ideally this experience will stay with students through residency and beyond, and hopefully they will begin incorporating screening for social determinants when they begin their practices,” Palakshappa said.