124 - Integrating Social Determinants of Health into Pediatric Clerkship Assessment

Poster Number: 124
Publication Number: 124.216

Emily N. Krasnow, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, hempstead, NY, United States; Victoria Timmel, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Astoria, NY, United States; Jill Leibowitz, Cohen Children's Medical Center, New hyde park, NY, United States; Roya Samuels, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, United States; rebecca dougherty, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Head, NY, United States

Background: Social Determinants of Health (SDOH) are known to create health disparities and impact clinical outcomes. However, specific strategies for incorporating SDOH into clinical clerkships remain sparse and no standardized measures currently exist to evaluate these curricular changes.

Objective: To assess if adding SDOH to the grading rubric increases student’s consideration of SDOH in patient write-ups.

Design/Methods: Pediatric clerkship students are required to submit “admission notes” for patients from whom they collected the history, performed a physical, and discussed diagnosis and management. These notes are graded on a rubric with scores contributing to a final clerkship grade. For the 2021 academic year, students were (1) instructed to pay closer attention to SDOH when gathering histories, and (2) the admission note rubric was modified to assess: (a) how a patient’s SDOH impacts their disease, (b) the impact of SDOH on the management plan, and (c) anticipation of their patient’s specific discharge needs. These criteria were measured on a binary scale of “did include” or “did not include.” Admission notes from the first clerkships of 2020 (n=11) and 2021 (n=15) were graded using the 2021 rubric by a faculty member not directly involved in the curricular change.

Results: In order to compare the admission notes before and after this curricular change, Welch’s t-test was performed for the three SDOH-related criteria added to the grading rubric. Prior to the curricular change, no students discussed the impact of SDOH on their patient’s disease, whereas 86.7% of students successfully did so after the change (p < 0.01). Similarly, no students discussed the impact of SDOH on their patient’s management plan in 2020, whereas 60% included this in 2021 (p < 0.01). While 18.1% of students anticipated patients’ unique discharge needs in 2020 admission notes, 93.3% of students did so in 2021 (p < 0.01).Conclusion(s): Medical students were more likely to incorporate components of a patient’s SDOH into graded write-ups when (1) instructed to conduct an SDOH screening and (2) advised that SDOH would be assessed in the grading rubric. Requiring evaluation of SDOH in graded write-ups may therefore increase consideration of SDOH among trainees.