What future doctors need to know about health determinants


Part of preparing future physicians to deliver the best care is teaching them about the nation’s vast variety of people, but understanding cultural differences requires more than just background in race, ethnicity and religion. Tomorrow’s doctors are learning more about socioeconomic status, gender, sexual orientation and other social determinants of health.

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Physicians nationwide support integrating more training on the social determinants of health into undergraduate medical education—they voted to make it AMA policy at the 2014 AMA Interim Meeting. The new policy includes supporting faculty development to ensure medical educators have the appropriate knowledge as well.

Under the new policy, the AMA will support medical schools in evaluating the effectiveness of their teachings on the social determinants of health and will work to gather data on medical students’ perspectives on the topic.

Educators shared what their schools are doing to tackle challenges in teaching the social determinants of health at a recent Google Hangout hosted by the AMA. Participants discussed how they’re training physicians, including addressing health disparities and focusing on diversity.

For example, some of the schools that are part of the AMA’s Accelerating Change in Medical Education initiative are tackling health care disparities. The University of California Davis School of Medicine is one such school, with a new three-year primary care program that includes an innovative admissions and recruitment strategy to select students from diverse backgrounds.

The goal is to help these students go on to practice in underserved communities as primary care physicians. One-half of the students admitted into the first class of the program are from groups historically underrepresented in medicine.

Other programs are working on addressing the needs of lesbian, gay, bisexual and transgender (LGBT) populations. At a recent education session hosted by the AMA Medical Student Section, students discussed health problems specific to these populations. For example, lesbian women have a higher risk of substance abuse.

“If you’re in the LGBT community, you are likely to be at a lower economic status, with less of a support system,” said Jilyan Decker, a second-year medical student at Rutgers New Jersey Medical School. “Maybe you have had experiences in the past that have given you fears about going to see the doctor.”

Understanding ethnogeriatrics—the way aging individuals are influenced by their culture, ethnicity, history, values and beliefs—is also crucial, said Phil Zegelbone, a third-year medical student at the University of South Florida College of Medicine.

“Consider an 85-year-old African American female,” he said. “Think about what this person’s view of health care might be.” This particular patient would have lived through multiple wars, the advent of the television, numerous medical advances and more—and all of these experiences factor into how the patient will interact with the health care system.

After the AMA works to help medical schools integrate teachings of social determinants of health into their curricula, study will begin on how such teachings can be folded into graduate medical education and continuing medical education.

How can future physicians learn about the social determinants of health? Share your ideas in a comment below at AMA Wire® or on the AMA Facebook page.