Systematic Approach to Promoting Healthcare Equity through Resident Education (SPHERE)

Project Summary

This project is exploring multiple aspects of how healthcare disparities and social determinants of health are measured, formally taught by faculty, and understood by primary care residents in internal medicine and family medicine.

SPHERE Project

There is a large body of public health research demonstrating that social conditions have a large influence on health and disease. Furthermore, social conditions that threaten health are more prevalent among racial/ethnic minorities and those living in socioeconomically deprived communities. While these facts are clearly established, best practices for teaching primary care residents about these topics are not. In the SPHERE project, we are collecting data to inform best practices for teaching primary care residents about the social determinants of health. Through our literature review and survey of residency program directors across the country, we have identified that there is a lack of consensus about what framework to use when developing curricula on social determinants of health or how to evaluate resident competency. We aim to develop and test curricular approaches to primary care residency training that will be useful to programs across the country and advance the field of resident education.

Supporting Literature

1. Galea S, Tracy M, Hoggatt K, DiMaggio C, Karpati A. Estimated deaths attributable to social factors in the United States. Am J Public Health. 2011;101(8):1456–1465.

2. Marmot M, Friel S, Bell R, Houweling TA, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661–1669.

3. Hernandez LM, Munthali AW, editors . Training Physicians for Public Health Careers. 1st ed. Washington, DC: The National Academies Press; 2007.

4. Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;(35):80–94.

5. McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff (Millwood). 2002;21(2):78–93.

6. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238–1245.

7. Schroeder SA. We can do better: improving the health of the American people. New Engl J Med. 2007;357(12):1221–1228.

8. Association of American Medical Colleges. Behavioral and Social Science Foundations for Future Physicians. Report of the Behavioural and Social Science Expert Panel. Washington, DC: Association of American Medical Colleges; 2011. Available from:¬futurephysicians.pdf. Accessed August 8, 2014.

9. Dannenberg AL, Quinlisk P, Alkon E, et al. US medical students’ rotations in epidemiology and public health at state and local health departments. Acad Med. 2002;77(8):799–809.

10. Finkelstein JA, McMahon GT, Peters A, Cadigan R, Biddinger P, Simon SR. Teaching population health as a basic science at Harvard medical school. Acad Med. 2008;83(4):332–337.

Join our network and get current research and curriculum.

Sign up for our newsletter to get recent blog posts, research updates and upcoming events.