A Case-Based Critical Care Curriculum for Internal Medicine Residents Addressing Social Determinants of Health

Date of Review: July, 2023

This 4-week case-based curriculum, from MedEd Portal, introduces internal medicine residents to SDOH topics relevant for adult critical care patients. The curriculum aims to increase resident knowledge and skills related to collecting an SDOH focused history (specifically using the Accountable Health Communities Health-Related Social Needs Screening Tool, or AHC HRSN), identifying how the SDOH impact the care of critically ill patients, and connecting patients to social resources. The primary learning modalities are problem-based learning and self reflection. The curriculum is implemented in the context of a 4-week ICU rotation with reserved time for group teaching at 2pm each day. One 30-minute afternoon session per week is dedicated to pairing a critical care topic with an SDOH topic. Prior to the session, residents or faculty select a case from among currently admitted patients and choose a SDOH topic to focus on. During the session, the facilitator guides participants through discussing how to apply the AHC HRSN Screening Tool to the case, why the SDOH topic is important to the clinical care of the patient, and resources available for that patient. Participants are also asked to reflect on prior experiences with similar patients and general concerns about addressing the SDOH. These sessions can be facilitated by any senior level resident or faculty and do not require significant content expertise. However, the curriculum does recommend that the facilitator meet with the unit social worker prior to each afternoon session in order to review the SDOH topic. The facilitation guide provides examples of high-yield SDOH topics and how they might be paired with critical care topics. These topics are insurance subsidy programs, advanced care planning and decision-making, housing insecurity, substance abuse disorders, refugee populations, and food insecurity. For each topic, facilitators are provided with a list of learning objectives, suggested learning activities, prompt questions, and additional online resources. There is some topic-specific content in the facilitation guide, primarily definitions of key terms. Many of the learning activities involve participants using the time to research the topic and then share back with the group. This means that the depth of discussion relies on the degree of participation from learners, the level of involvement from social work, and any prior knowledge on the part of the facilitator. One main strength of this curriculum is that it is embedded within a clinical rotation, giving participants an immediate opportunity to apply their learning to patient care. The curriculum also provides a templated form that social workers can use to give learners feedback on their assessment of social risk during patient presentations and multidisciplinary rounds. This curriculum requires weekly dedicated teaching time, though 30 minutes per week seems feasible for most clinical environments. Implementation also depends on involvement of social work to provide important content expertise. Overall, this curriculum provides a good framework for integrating SDOH topics with clinical content that could even be applied outside the ICU to other clinical learning environments. —Emma Anselin, MD, NCEAS

Corresponding Author’s Email:

deepa.ramadurai@pennmedicine.upenn.edu

Institution:

University of Colorado

Where was the Curriculum Implemented:

Colorado

Clinical Specialty:

Internal Medicine

Outcomes that Have Been Reported for the Curriculum:

Self-reported learner knowledge

Self-reported learner attitude

Measured learner behavior in real patient setting

Outcome and Study Design:

Pre/Post

Level of Learner Assessment

Appreciation of content/attitude assessment (self-reflection, blogging with rubric)

Demonstration of skill with patients in the clinical or community setting (direct observation, 360 assessment, patient surveys)