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122 muster2014 Dickey
This document summarizes a presentation on social determinants of health and upstream medicine given at a global health conference. It discusses how health is determined by multiple social and environmental factors beyond just medical care. The presentation advocates for medical education that exposes students early to these broader determinants of health through real-world experiences with patients. It describes a curriculum implemented at Texas A&M involving students visiting patients at home and in clinics to learn how social issues impact health and develop plans to address one identified social determinant. Performance is assessed based on documentation and understanding of links between social factors and medical issues.
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122 muster2014 Dickey
- 1. Social Determinants ofHealth – Upstream Medicine Presented at the Global Community Engaged Medical Education Muster Uluru, Northern Territory 27-30 October, 2014 By Nancy W Dickey, MD Professor, Department of Family Medicine Texas A&M University Health Science Center College of Medicine
- 2. Faculty/Presenter Disclosure Slide1 • Faculty: Nancy W Dickey, MD • Relationships with commercial interests: – Consulting Fees: Association of Academic Health Centers – Others: Employee of Texas A&M University Heatlh Science Center College of Medicine
- 3. Disclosure of Commercial Support Slide 2 • This program has received in-kind support from Texas A&M University Health Science Center in the form of travel support • AAHC consulting is not related to this forum. • Potential for conflict(s) of interest: None Nancy W Dickey, MD, has received funding from Texas A&M University Health Science Center supporting this program.
- 4. Mitigating Potential Bias Slide 3 • The AAHC consulting is not related to curriculum development or this conference. • The support of the University is in support of an expectation of developing curriculum and sharing best practices across the globe. A full report will be made back to the university regarding my presentation and additional lessons learned for incorporation into university curriculum.
- 5. Achieving “Total Health”requires attention beyond the exam room…. Health is driven by multiple factors that are intricately linked—of which medical care is one component. Total Health is a comprehensive solution that addresses all components. Drivers of Health Source: Determinants of Health and Their Contribution to Premature Death. JAMA 1993 | © 2011 Kaiser Foundation Health Plan, 5 November 27, 2014 Inc.
- 6. Teaching students the breadth of their role… • Get them early so they learn this is important – even before they begin to learn physical diagnosis and differential diagnosis • Living laboratory • “Relatively blatant examples • Sticky” learning – Associated with real patients – Practice assessment & judgment • As with procedural skills, technique, sequence, and practice help promote “muscle memory”
- 7. The Curriculum •WHEN: During the pre clerkship training phase • WHO: M-1 Students in a longitudinal experience through first 10 months of pre-clerkship education • HOW: Selected reading & discussion to learn concepts Active Learning Process through patient/client interaction • Assign two students to a patient • Facilitate home visits • Attend one or more clinic visits and access clinic medical records • Each team will select ONE social issue that impacts the health measure/outcome of the assigned patient • Develop a plan to address the social “upstream” issue selected • Additional credit for any team of students that actually takes steps to implement the plan
- 8.
- 9. Assessing Performance… •Readings followed by small group discussion • Documentation of clinic and home visits – Demonstration of understanding link between upstream issues and medical issues • Description of selection of social/upstream issue(s) – Demonstration of understanding of concept • Reasonableness of recommended plan/intervention *Steps taken to actually implement may lead to additional credit
- 10.
Editor's Notes
- #6 There are health behaviors, social, economic, and environmental factors that determine the quality and length of life. Behaviors than can negatively impact health include smoking, lack of exercise, unhealthy diets, alcohol use and unsafe sex practices. Social and economic factors include education, employment, income, family and social support, and community safety The physical factors include the quality of the environment But for the purposes of educating medical students, we tend to spend an inverse portion of time i.e. 90% on medical care, 7% (and that only recently) on genetics and personal behavior and less than 5% on environmental and social factors – and we usually promptly refer them to someone else to deal with those issues.
- #8 Outlines the skills, performances, attitudes, and values pupils are expected to learn from schooling. It includes statements of desired pupil outcomes, descriptions of materials, and the planned sequence that will be used to help pupils attain the outcomes. The total learning experience provided by a school. It includes the statements of desired pupil outcomes, descriptions of materials, and the planned sequence that will be used to help pupils attain the outcomes., which relate to the way the school is organized.
- #9 statements of desired pupil outcomes, descriptions of materials, and the planned sequence that will be used to help pupils attain the outcomes. the skills, performances, attitudes, and values statements of desired pupil outcomes, descriptions of materials, and the planned sequence that will be used to help pupils attain the outcomes.
- #10 statements of desired pupil outcomes, descriptions of materials, and the planned sequence that will be used to help pupils attain the outcomes. the skills, performances, attitudes, and values statements of desired pupil outcomes, descriptions of materials, and the planned sequence that will be used to help pupils attain the outcomes.