Investigators at Cincinnati Children’s Hospital Medical Center (CCHMC) sought to evaluate the impact of a social determinants of health (SDH) curriculum on residents’ competency in screening for and managing SDH as well as parental perceptions of resident trust, respect, and engagement on SDH-related issues. Second- and third-year pediatric residents in a CCHMC-based continuity clinic were eligible for the study. Tuesday–Thursday continuity clinic residents were assigned to the control group and Monday-Wednesday-Friday residents to the intervention group. The study was implemented in 3 phases: (1) phase 1 – all residents completed a survey on self-assessed competence for SDH screening and management; 3 families seen by each study resident were asked to assess their level of trust and respect for the resident and how the resident assessed SDH during their visit; (2) phase 2 (2 months later) – intervention residents received the SDH curriculum, which included 2 ninety-minute conferences over 2 successive months, beginning with a brief didactic presentation on SDH, followed by a faculty-facilitated discussion of video vignettes illustrating appropriate and inappropriate ways to screen for SDH, and concluding with “day in the life’ videos of actual clinic families discussing how screening, detection, and intervention impacted their lives; (3) phase 3 – all residents and 3 additional families were asked to complete the same respective surveys as in phase 1. The primary outcomes were residents’ self-assessed competence in screening and managing SDH, parental perceptions of trust and respect in the resident, and parent report of screening for SDH issues.
All eligible residents participated (N=47), with 23 in the control group and 24 in the intervention group. There was no difference between intervention and control residents in their phase 1 self-assessed competence in screening and managing SDH, parent rating of resident trust and respect, or parent-reported SDH screening obtained in phase 1. However, intervention residents’ phase 3 self-assessed competence in screening for housing, benefits, and educational SDH concerns was significantly higher than control residents’ (P ≤ .05 for each). There was no difference between intervention and control residents in phase 3 self-assessed competence for managing SDH. Parents’ phase 3 ratings of resident trust and respect were similar to phase 1 ratings and not different between resident groups. However, phase 3 parent-reported screening for domestic violence and depression was significantly higher among intervention residents compared to control residents.
The investigators conclude that the SDH curriculum improves resident competencies in parental perceptions of SDH screening.
Dr Schreiber and Ms Schwarz have disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
More than 16 million children (22%) in the United States live in families with incomes below the federal poverty level. It has...