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Review
. 2023 Aug 1;98(8):941-948.
doi: 10.1097/ACM.0000000000005207. Epub 2023 Jul 21.

Consensus on Social Determinants of Health Knowledge Topics and Behavior Learning Goals Across Primary Care Residencies: Results of a Delphi Study

Iman F Hassan  1 , Victoria Gorski  2 , Dana Sanderson  3 , Sandra Braganza  4 , Nerys Benfield  5 , Marisa Nadas  6 , Erka Amursi  7 , Cristina M Gonzalez  8
Affiliations
Review

Consensus on Social Determinants of Health Knowledge Topics and Behavior Learning Goals Across Primary Care Residencies: Results of a Delphi Study

Iman F Hassan et al. Acad Med. .

Abstract

Purpose: Social determinants of health (SDH) are a substantial contributor to health outcomes and health inequities across populations. The Accreditation Council for Graduate Medical Education has called for the incorporation of SDH into graduate medical education (GME), yet there is no consensus on what SDH knowledge or skills residents in primary care specialties should have on completion of training. The aim of this study was to develop expert consensus on the most important SDH knowledge topics and behavior learning goals for residents in 4 primary care fields.

Method: The authors used a modified Delphi technique to develop consensus among experts in internal medicine, pediatrics, family medicine, and obstetrics and gynecology across the United States via a survey administered between February and October 2021. They conducted a literature review on SDH in GME to develop an initial set of topics and learning goals and recruited experts who published about SDH and GME or led an SDH curriculum in GME. Consensus was determined a priori as 80% agreement that a topic or learning goal was very or extremely important.

Results: Forty-one experts participated in the first round of the survey and 33 participated in the second round (80% retention). Experts reached consensus on the importance of 22/51 (43%) topics and 18/47 (38%) learning goals. Topics reaching consensus emphasized structural forces, broad domains of SDH, resources for addressing SDH, and advocacy strategies and resources. Learning goals reaching consensus focused on individual- and interpersonal-level behaviors.

Conclusions: To the authors' knowledge, this study represents the first rigorous evaluation of expert consensus on SDH in GME across 4 primary care specialties. The results could inform curriculum development and implementation and program evaluation, residency program goals, and shared GME milestones. Among other things, future studies can assess expert consensus on SDH in GME across nonprimary care specialties.

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References

    1. World Health Organization. Social Determinants of Health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1 . Accessed February 9, 2023.
    1. Gómez CA, Kleinman DV, Pronk N, et al. Addressing health equity and social determinants of health through Healthy People 2030. J Public Health Manag Pract. 2021;27(Suppl 6):S249–S257.
    1. Accreditation Council for Graduate Medical Education. The Program Director’s Guide to the Common Program Requirements (Residency). https://www.acgme.org/globalassets/PFAssets/ProgramResources/PDGuideResi... . Updated January 31, 2020. Accessed February 9, 2023.
    1. Gonzalo JD, Chang A, Dekhtyar M, Starr SR, Holmboe E, Wolpaw DR. Health systems science in medical education: Unifying the components to catalyze transformation. Acad Med. 2020;95:1362–1372.
    1. Koh NJ, Wagner R, Newton RC, Kuhn CM, Co JPT, Weiss KB; CLER Evaluation Committee and the CLER Program. CLER National Report of Findings 2021. Chicago, IL: Accreditation Council for Graduate Medical Education; 2021. https://www.acgme.org/globalassets/pdfs/cler/2021clernationalreportoffin... . Accessed February 9, 2023.

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