PS2-08: INTEGRATING ADVOCACY TRAINING INTO THE THIRD YEAR SURGICAL CLERKSHIP
Kris Boelitz1, Megan Janeway, MD2, Susanna W.L. de Geus, MD, PhD2, Lisa Allee, MSW, LICSW2, Sabrina Sanchez, MD, MPH2, Tracey Dechert, MD2; 1Boston University School of Medicine, 2Boston Medical Center
Purpose: It is widely accepted that throughout medical education, it is a practical and ethical necessity to introduce advocacy curricula, yet few exist in surgical education. This study assesses the impact of integrating a social determinants of health (SDH) curriculum in the Third-Year Surgery Clerkship on student’s knowledge, attitudes and self-confidence to identify and address a patient’s SDH.
Methods: This prospective, randomized trial with pretest-posttest evaluation was conducted over three years to assess the efficacy of the intervention in third-year surgical rotations. Participants were asked to complete a 50-item survey at the beginning and the end of the clerkship block. Participants were divided into intervention (n=151) and control (n=74) groups randomly by alternating clerkship blocks. The intervention consisted of a didactic session on SDH in surgery and a requirement of students during the clerkship block to identify non-medical barriers to care, ask SDH screening questions, show sensitivity to these complex issues, and offer at least one appropriate referral to the patient. Intervention students received a resource card outlining SDH screening questions and resources available for patient referrals. Surveys consisted of 3 subscales assessing knowledge, attitudes and efficacy/confidence toward SDH assessment. Subscale scores were analyzed using paired t-test and analysis of variance to compare changes in scores and between intervention and non-intervention groups.
Results: A total of 225 (68%) of third year medical students in the surgery clerkship from 2015-2018 completed both pre- and post-surveys. There was no significant difference in pre-test post-test mean scores in the non-intervention group (7.325±0.601) and the intervention group (mean 7.735 ±0.247) (p=0.41). The increase in mean scores measuring self-efficacy and confidence assessing and intervening on the SDH was significantly higher in the intervention group (11.59±0.6788) than the control group (10.92±0.1697) (p<0.05). Those in the intervention group demonstrated a 3-fold increase in ability to identify barriers to care.
Conclusions: Implementation of a modest educational intervention in assessing the SDH of patients that includes integrating these skills during the clerkship improves the abilities of medical students to address the social barriers to surgical care and change their perceptions of their own roles and the roles of surgeons.