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A Way to Contextualize the Social Determinants of Health (SDOH): Integrating Lived Experience Panels into Medical Education

Given the importance of the social determinants of health (SDOH) in driving health outcomes and inequities in population health, the Liaison Committee on Medical Education has recognized the need to provide SDOH training during undergraduate medical education since 2016 (1). During this time, there has been progress towards integrating SDOH education with most medical schools offering some type of curricula as a part of formal training. Though the exact type of curricula varies greatly and has evolved beyond lectures to include simulations, needs assessments, community engagement and a variety of activities aimed at placing the learner in the shoes of the patient, we need as many tools as possible in the ever-expanding toolkit to engage our students in new ways (2).

At the University of Texas Medical Branch (UTMB), we integrated SDOH content as a main pillar of the first course of medical school called Mindfully Evolving Thriving & Advocating (META). In addition to lectures on health policy, SDOH, adverse childhood experiences and racism in medicine, we contextualized the science and data with Lived Experience Panels (LEPs).  We invited real patients to be vulnerable and speak with honestly and bravely about their life experiences. We had different panel sessions on the themes of Incarceration, LGBTQI+ care, chronic disease and disability. Patients served as educators, self-experts and storytellers contextualizing their illness in the tapestry of their lives. We leveraged the connection of storytelling, the empowerment of patients sharing their life histories and opportunity to sculpt their own narratives- in doing so, they were able to overcome the imaginative limitations of data alone.

Students were able to build empathy and understanding of individuals who were often very different from themselves. They gained early exposure to the importance of listening to patient narratives in their own words and were able to gain understanding of the multiple impacts of SDOH (financial, poverty, racism, housing, transportation, etc) on the life trajectory of individuals and families.

The structure of the panels varied somewhat based on the needs of the patients and students. See table 1 for each format.

Table 1

Session Theme Pre-work for students Session Format
Incarceration

   Read Mass Incarceration Threatens Health Equity in America article (3)
  1. Small Group Discussion with Students over pre-prepared questions (from the reading via breakout rooms)
  2. Facilitated Discussion with Panelists moderated by a faculty member
    1. (4 panelists: 1 physician, 3 policy experts. All policy experts with experience in justice system themselves or secondary as family members)
  3. Q&A from Students (moderated from chat)
LGBTQI+

 Read a document on gender, sexuality, pronouns, etc.
  1. Introduction of all participants
  2. Moderated discussion by pre-selected prompts for all
  3. Q&A with students
    1. This session was followed by a formal Allies in Health LGBTQI+ training
Chronic Disease

View taking care of Complex Patient Powerpoint

 Read Importance of Physician Listening article (4)
  1. Introduction of all participants
  2. Mother tells the story of her daughter
  3. Care team tells their perspective (MD, OT, SW)
  4. Mom signs off
  5. Q&A with students and care team
Disability

 View a video on www.positiveexposure.org and answer prompts
  1. Short introduction by 2 student moderators
  2. Introduction of all patients and their families
  3. Each family tells their story
  4. Families are invited to give advice to future doctors
  5. Brief Q&A
  6. Didactic of best practices

Given the importance of the social determinants of health (SDOH) in driving health outcomes and inequities in population health, the Liaison Committee on Medical Education has recognized the need to provide SDOH training during undergraduate medical education since 2016 (1). During this time, there has been progress towards integrating SDOH education with most medical schools offering some type of curricula as a part of formal training. Though the exact type of curricula varies greatly and has evolved beyond lectures to include simulations, needs assessments, community engagement and a variety of activities aimed at placing the learner in the shoes of the patient, we need as many tools as possible in the ever-expanding toolkit to engage our students in new ways (2).

At the University of Texas Medical Branch (UTMB), we integrated SDOH content as a main pillar of the first course of medical school called Mindfully Evolving Thriving & Advocating (META). In addition to lectures on health policy, SDOH, adverse childhood experiences and racism in medicine, we contextualized the science and data with Lived Experience Panels (LEPs).  We invited real patients to be vulnerable and speak with honestly and bravely about their life experiences. We had different panel sessions on the themes of Incarceration, LGBTQI+ care, chronic disease and disability. Patients served as educators, self-experts and storytellers contextualizing their illness in the tapestry of their lives. We leveraged the connection of storytelling, the empowerment of patients sharing their life histories and opportunity to sculpt their own narratives- in doing so, they were able to overcome the imaginative limitations of data alone.

Students were able to build empathy and understanding of individuals who were often very different from themselves. They gained early exposure to the importance of listening to patient narratives in their own words and were able to gain understanding of the multiple impacts of SDOH (financial, poverty, racism, housing, transportation, etc) on the life trajectory of individuals and families.

The structure of the panels varied somewhat based on the needs of the patients and students. See table 1 for each format.

-Premal Patel, MD Community of Practice Member

Dr. Premal Patel is a board-certified Physician and an Associate Professor in the Department of Internal Medicine. She also serves as the Associate Director of the Global Health Education Program at UTMB and is co-coordinator of the Global Health Inter-Professional Core Course.

References:

  1. Mangold, Karen A. MD, MEd; Bartell, Tami R. MPH; Doobay-Persaud, Ashti A. MD; Adler, Mark D. MD; Sheehan, Karen M. MD, MPH Expert Consensus on Inclusion of the Social Determinants of Health in Undergraduate Medical Education Curricula, Academic Medicine: September 2019 – Volume 94 – Issue 9 – p 1355-1360 doi: 10.1097/ACM.0000000000002593
  2. Doobay-Persaud A, Adler MD, Bartell TR, Sheneman NE, Martinez MD, Mangold KA, Smith P, Sheehan KM. Teaching the Social Determinants of Health in Undergraduate Medical Education: a Scoping Review. J Gen Intern Med. 2019 May;34(5):720-730. doi: 10.1007/s11606-019-04876-0. PMID: 30993619; PMCID: PMC6502919.
  3. Acker J, Braveman P, Arkin E, Leviton L, Parsons J, Hobor G. Mass Incarceration Threatens Health Equity in America. Executive Summary. Princeton, NJ: Robert Wood Johnson Foundation, 2019.
  4. Jagosh J, Donald Boudreau J, Steinert Y, Macdonald ME, Ingram L. The importance of physician listening from the patients’ perspective: enhancing diagnosis, healing, and the doctor-patient relationship. Patient Educ Couns. 2011 Dec;85(3):369-74. doi: 10.1016/j.pec.2011.01.028. Epub 2011 Feb 18. PMID: 21334160.
  5. Lewis JH, Lage OG, Grant BK, et al. Addressing the Social Determinants of Health in Undergraduate Medical Education Curricula: A Survey Report. Adv Med Educ Pract. 2020;11:369-377. Published 2020 May 22. doi:10.2147/AMEP.S243827

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