Making A Difference: Launching a Multimodal, Resident-Run Social Emergency Medicine Program

Abstract

Introduction: Social medicine seeks to incorporate patients' social contexts into their medical care. Emergency physicians are uniquely positioned to address social determinants of health (SDoH) on the frontlines of the healthcare system. Miami-Dade County (MDC) is a diverse and socially vulnerable area. In 2020, the University of Miami-Jackson Health System (UM-JHS) emergency medicine (EM) residency program launched a multimodal, resident-led Social EM program to identify and address SDoH in the emergency department (ED).

Methods: We use a four-pillar approach to SDoH in the ED: Curriculum Integration; Community Outreach; Access to Care; and Social Justice. Residents graduate with a knowledge of Social EM principles through an 18-month curriculum, an elective, and a longitudinal track. We developed sustainable initiatives through interdepartmental and community-based partnerships, including a Narcan distribution initiative, an ED-based program linking uninsured patients to follow-up care, a human trafficking education initiative, and a quality improvement initiative for incarcerated patients.

Results: Given that the 18-month curriculum was launched in 2022, a full rotation of the curriculum had not been completed as of this writing, and data collection and analysis is an ongoing process. The initial pretest and post-test survey data show improvement in knowledge and confidence in managing Social EM topics. The Narcan initiative has screened 1,188 patients, of whom 144 have received Narcan. The ED-based patient navigation program has enrolled 31 patients to date, 18 of whom obtained outpatient care. Analysis of the impact/effectiveness of the program's other initiatives is ongoing.

Conclusion: To our knowledge, this is one of the most robust social EM programs to date, as many other programs primarily focus on service opportunities. Rooted in the revised principles of Bloom's taxonomy of cognitive learning, this program moves beyond understanding Social EM tenets to generating solutions to address SDoH in and outside the ED.

Figure 1.

Social emergency medicine program organization and division of labor. Program directors consist of one faculty director and 1–4 resident directors (EM residents selected via a formal application process). Program directors oversee initiatives across all four pillars but spend additional time leading Curriculum Integration initiatives to ensure a seamless incorporation of Social EM principles into residency training. Pillar leaders are EM residents who are selected by program directors via a formal application process; they design and oversee initiatives in their assigned pillars. Faculty mentors are generally core faculty in the EM department with expertise in their assigned pillar. However, faculty in other specialties at UM-JHS may also serve as mentors if they currently oversee a community or hospital-based initiative that collaborates with the Social EM program. (For example, a faculty mentor from the family medicine department oversees the IDEA Needle Exchange Clinic.) Anyone affiliated with the EM department may serve as a team member. Team members work directly with their assigned resident leaders and divide the tasks required to launch and publicize initiatives.

Figure 2.

Point system for the 18-month longitudinal track. Note that opportunities in each pillar may vary over time. This figure lists opportunities from the fall of 2023.

Figure 3.

Comparison of key pre- and post-survey results after a simulation session on highly communicable diseases/STI epidemics; 30 residents completed the surveys. After the session, residents indicated an increased confidence in their ability to recognize acute HIV and initiate Highly Active Antiretroviral Therapy (HAART) or Pre-Exposure Prophylaxis (PrEP) treatment when indicated. Most residents found the session beneficial in learning about community resources for ED patients with HIV, as well as prescribing HAART and PrEP.