training medical students in the social determinants of health: the health scholars program at puentes de salud

Matthew J O’Brien,1–4 Joseph M Garland,4,5 Katie M Murphy,4,6,7 Sarah J Shuman,3,4 Robert C Whitaker,1,3,8 Steven C Larson4,9 1Center for Obesity Research and Education, Temple University, Philadelphia, PA, USA; 2Department of Medicine, Section of General Internal Medicine, Temple University of Medicine, Philadelphia, PA, USA; 3Department of Public Health, Temple University, Philadelphia, PA, USA; 4Puentes de Salud Health Center, Philadelphia, PA, USA; 5Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 6Master of Public Health Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 7Graduate School of Education, University of Pennsylvania, Philadelphia, PA, USA; 8Department of Pediatrics, Temple University School of Medicine, Philadelphia, PA, USA; 9Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Purpose: Given the large influence of social conditions on health, physicians may be more effective if they are trained to identify and address social factors that impact health. Despite increasing interest in teaching the social determinants of health in undergraduate medical education, few models exist. Participants and methods: We present a 9-month pilot course on the social determinants of health for medical and other health professional students, which is based at Puentes de Salud, Philadelphia, PA, USA, a community health center serving a Latino immigrant population. This service-learning course, called the Health Scholars Program (HSP), was developed and implemented by volunteer medical and public health faculty in partnership with the community-based clinic. The HSP curriculum combines didactic instruction with service experiences at Puentes de Salud and opportunities for critical reflection. The HSP curriculum also includes a longitudinal project where students develop, implement, and evaluate an intervention to address a community-defined need. Results: In our quantitative evaluation, students reported high levels of agreement with the HSP meeting stated course goals, including developing an understanding of the social determinants of health and working effectively with peers to implement community-based projects. Qualitative assessments revealed students’ perception of learning more about this topic in the HSP than in their formal medical training and of developing a long-term desire to serve vulnerable communities as a result. Conclusion: Our experience with the HSP suggests that partnerships between academic medical centers and community-based organizations can create a feasible, effective, and sustainable platform for teaching medical students about the social determinants of health. Similar medical education programs in the future should seek to achieve a larger scale and to evaluate both students’ educational experiences and community-defined outcomes. Keywords: social determinants of health, medical education, service-learning, Hispanic health