Evaluating Innovation and Challenges to Social Determinants of Health Education in the Context of a Pandemic

It is unclear what the impact of the twin pandemics of COVID-19 and racism has been on approaches to train health professions students to address underlying causes of health inequities. For many institutions, there has been an abrupt shift in the methods used to deliver educational content. Most notably, many institutions are primarily relying on remote learning and limiting teaching within clinical and classroom settings. In addition, there may be rapid shifts in content being delivered. As a result, while there is clear urgency for training in SDOH and antiracism, it is unclear whether the pandemic and racial unrest have hindered or enhanced efforts to do so.

Project Summary

In light of the twin pandemics of COVID-19 and racism, the full scope of educational challenges, beyond remote learning, such as changes in funding support for educators, changes in clinical effort for educators on the frontlines, and shifting relationships with community-based organizations, is yet to be determined. Furthermore, there are likely student, educator, institutional, and community characteristics that may enhance or hinder SDOH education and innovation, even when learning environments undergo rapid changes. This study proposes that educational settings that 1) have greater proportions of underrepresented minority students, 2) are associated with medical centers that serve higher proportions of patients who participate in public health plans, and 3) had investment in experiential learning prior to COVID, had the most sizeable shifts in their educational environments as a result of COVID- 19 and a renewed focus on racial justice.

Changes in SDOH Curriculum and Antiracist Efforts in the Context of a Pandemic

Early in the course of the COVID-19 pandemic, numerous reports began highlighting increased morbidity and mortality from the infection among people with chronic diseases such as diabetes, hypertension and obesity (1). Almost in parallel, additional studies began also describing the disparate toll of COVID-19 on Black and Latinx populations, those with chronic homelessness, and among those who are incarcerated (2-4).

To stave the spread of the virus, particularly to those at highest risk, the Centers for Disease Control recommended strict containment measures, including social distancing and remote learning (5). Given the well-known relationship between the inequitable distribution of social risks among different communities, and the relationship between social risks, development of chronic illnesses, and inability to socially distance, the disproportionate toll of disease on some communities should come as no surprise. Further drawing attention to disparities resulting from structural inequities were the killings of Breonna Taylor, Ahmaud Arbery, and the public murder of George Floyd. Their deaths resulted in intensified calls to reexamine underlying structures, such as correctional systems, and actively develop and implement new policies, procedures and institutions grounded in equity.

In the midst of this massive cultural awakening, the role of health care institutions in perpetuating or identifying and addressing inequities through training has come sharply into focus. This study seeks to identify the institutional characteristics of US medical schools that maintain or increase the robustness of medical education through focus on the social determinants of health.

Supporting Literature:

  1. Team CC-R. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 – United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(13):382-386.
  2. Nowotny K, Bailey Z, Omori M, Brinkley-Rubinstein L. COVID-19 Exposes Need for Progressive Criminal Justice Reform. Am J Public Health. 2020:e1-e2.
  3. Shah M, Sachdeva M, Dodiuk-Gad RP. COVID-19 and Racial Disparities. J Am Acad Dermatol. 2020.
  4. Tobolowsky FA, Gonzales E, Self JL, et al. COVID-19 Outbreak Among Three Affiliated Homeless Service Sites – King County, Washington, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(17):523- 526.
  5. Control CfD. Social Distancing, Quarantine, and Isolation. 2020; https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html. Accessed May 6, 2020.

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