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A Case-Based Critical Care Curriculum for Internal Medicine Residents Addressing Social Determinants of Health.

  • Ramadurai, Deepa1
  • Sarcone, Ellen E2
  • Kearns, Mark T3
  • Neumeier, Anna3
  • 1 Fellow of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania.
  • 2 Assistant Professor, Division of Hospital Medicine, Denver Health and Hospital Authority.
  • 3 Assistant Professor, Division of Pulmonary Sciences and Critical Care Medicine, Denver Health and Hospital Authority; Assistant Professor, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus.
Published Article
MedEdPORTAL : the journal of teaching and learning resources
Publication Date
Mar 18, 2021
DOI: 10.15766/mep_2374-8265.11128
PMID: 33816790


Graduate medical education on social determinants of health (SDOH) is limited. Residents often directly care for vulnerable populations at safety-net hospitals, yet curricula thus far are based in the ambulatory setting. We developed a case-based curriculum integrating SDOH with critical care topics to standardize knowledge and improve skills and attitudes of internal medicine residents working with these patients. We conducted a needs assessment, identified systematic social risk domains, and modified a published curriculum to develop the content. Case-based discussions were conducted weekly in the medical intensive care unit, while knowledge, attitudes, and skills were assessed daily during multidisciplinary rounds. A 360-degree assessment was completed with pre- and postcurriculum surveys and self-reflection. Eleven residents completed postcurriculum surveys. Both pre- and postcurriculum, residents reported confidence in identifying and describing how SDOH affect care. After the curriculum, residents could name more resources for patients experiencing health disparities due to substance abuse (pre: 47%, post: 73%) and financial constraints (pre: 50%, post:64%). This curriculum was recognized as the first training many residents received (pre: 31%, post: 91%) with formal feedback (pre: 16%, post: 64%). Implementing a curriculum of social risk assessment in critically ill patients was difficult due to competition with clinical care. Participating residents said they "loved the open dialogue" to reflect on their experiences; this became an avenue to "debrief on specific patient encounters and [how] SDOH brought [patients] to the ICU." Future directions include qualitative analysis of reflections and assessment of curricular impact on trainee resiliency. © 2021 Ramadurai et al.

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