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. 2020 Nov 25;20(1):470.
doi: 10.1186/s12909-020-02391-z.

Students' understanding of social determinants of health in a community-based curriculum: a general inductive approach for qualitative data analysis

Sachiko Ozone  1 , Junji Haruta  2   3 , Ayumi Takayashiki  2 , Takami Maeno  2 , Tetsuhiro Maeno  2
Affiliations

Students' understanding of social determinants of health in a community-based curriculum: a general inductive approach for qualitative data analysis

Sachiko Ozone et al. BMC Med Educ. .

Abstract

Background: A community-based medical education (CBME) curriculum may provide opportunities to learn about the social determinants of health (SDH) by encouraging reflection on context, but the categories that students can learn about and their level of reflection are unclear. We aimed to analyze medical students' understanding and level of reflection about SDH in a CBME curriculum.

Methods: Study design: General inductive approach for qualitative data analysis. Education Program: All 5th-year and 6th-year medical students at the University of Tsukuba School of Medicine in Japan who completed a mandatory 4-week clinical clerkship in general medicine and primary care during October 2018 and May 2019 were included. The curriculum included 3 weeks of rotations in community clinics and hospitals in suburban and rural areas of Ibaraki Prefecture. On the first day, students learned about SDH through a lecture and a group activity. As an SDH assignment, they were instructed to prepare a structural case description using the Solid Facts framework based on encounters during the curriculum. On the final day, they submitted the structural reflection report.

Analysis: Content analysis was based on the Solid Facts framework. Levels of reflection were categorized as reflective, analytical, or descriptive.

Results: We analyzed 113 SDH case descriptions and 118 reports. On the SDH assignments, the students frequently reported on social support (85%), stress (75%), and food (58%), but less frequently on early life (15%), unemployment (14%), and social gradient (6%). Of the 118 reports, 2 were reflective, 9 were analytical, and 36 were descriptive. The others were not evaluable.

Conclusions: The CBME curriculum enabled medical students to understand the factors of SDH to some extent. Further work is needed to deepen their levels of reflection.

Keywords: Community based education; Primary care education; Social determinants of health.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Overview of the social determinants of health program in the community-based medical education program at the University of Tsukuba School of Medicine
Fig. 2
Fig. 2
Number of students who listed each factor in the Solid Facts 2nd edition in the social determinants of health assignments
See this image and copyright information in PMC

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