MEDU-4090 - Social Medicine: Beyond Biological Basis of Health and Disease

MEDU-4090 - Social Medicine: Beyond Biological Basis of Health and Disease

Elective Title: Social Medicine: Beyond Biological Basis of Health and Disease
Course Number: MEDU-4090
Elective Type: career Duration/Weeks: 4 Max Enrollment: 20
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Hani Serag, MD, MPH Periods Offered: 4, 6 excluding holiday period 8 
Coordinator: Kiki Baldwin Other Faculty: Premal Patel, MD, MPH Wei-Chen Lee, PhD; Michael Goodman, Dr. PH, MPH; Shannon Guillot-Wright, PhD
Location to Report on First Day:
Mary Moody Northern (Rm # TBD)

Goals
The course aims primarily to enhance the clinical decision through:
(a) a better understanding of the socioeconomic basis of health and disease, and
(b) acquiring skills to screen for social determinants of health.

Objectives
By the end of the elective, students should be able to
1. Discuss different definitions of health and their implications for conceptualizing healthcare and role health personnel.
2. Define social determinants of health and discuss biosocial causal pathways linking social factors to population and individual health outcomes.
3. Discuss ways the current and recent reforms in the U.S. health system support a social determinants approach.
4. Recognize upstream approaches to health and their importance in clinical care.
5. Understand why hearing the patient's story, including a social history, is integral to the doctor-patient encounter and recognize ways to appropriately elicit and respond to this story in a clinical setting.
6. Utilize the methods of evidence-based medicine to assess various social risk factors during a patient encounter and account for these in the formulation of the patient plan.
7. Provide students the tools to more critically identify, read, interpret and engage the scientific literature regarding biomedical health care.
8. Introduce the concept of human rights and discuss its relationship to health care and health outcomes.
9. Compare and critically assess the American healthcare system in relation to other international healthcare systems with a particular focus on human rights.
10. Utilizing a social determinants approach, recognize barriers to care for vulnerable populations and identify community resources to address those barriers.

Description of course activities
Broadly defined as the "social determinants of health", social, political, economic, and cultural factors play a significant role in the kinds of health problems a particular population faces, whether and what kind of health care it receives, as well as in its health outcomes.
The course will consist of four general components:

1. Lectures: The lectures will be designed to introduce definitions, conceptual frameworks, evidence around
1.1. Social Determinants of Health, Health Disparities, Health Equity, and Social Medicine ;
1.2. Choosing and implement a social determinants assessment tool;
1.3. Developmental Origins of Disease (e.g., fetal origins, ACES), Health and Hierarchy (e.g., White Hall studies, allostatic load in humans and animals), Implicit Bias and Provider Behavior; and
1.4. The role of health systems and providers in addressing social determinants of health.

2. Problem-Based learning through well-designed exercises to enhance e the analytical and problem-solving capacities.

3. Readings/videos/online material - Recently published and milestone literature will be given as reading materials. We will classify them into mandatory and elective readings.

4. Community Engagement. During the course, students will be required to spend one morning or evening at one or two identified clinics (e.g., Dr Patel's clinic, Luke Society clinic). Students will also be required to visit one of the community-based organizations (CBOs) in Galveston that address some of the social determinants. Instructions for what they will do in each setting will be given on the first and second days of class, with in-class discussions. If you do not have transportation, please make arrangements with one of your classmates or the instructor to get to your required sites. Besides the 5 hours of clinical time, there will be about 25 hours faculty, self-directed time & community engagement activities. This will form a minimum of 30 hours per week.

Type of students who would benefit from the course
All medical students who completed year 2 especially those who like to pursuit a research career with their academic practice.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday
Tuesday 1:30-4:00
Wednesday
Thursday 1:30-4:00
Friday
Saturday
Sunday

 Average number of patients seen per week: 2
 Call Schedule: N/A

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
Data-Collection/Analysis
Other


Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    Students will be asked to practivce screening for social determinants of health in ambulatory clinical setting. They will use standard screening tools.
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Elective peers, course faculty members, and 3-5 invited other faculty
  B. Frequency / Duration of Presentation(s)?
    Each student will make one 15-minute oral presentation at the end of the elective. The presentation will be arranged on one or more days depends on the number of students.
  C. Format - What guidelines are set for the student's presentation?
    Format: 10 minutes presentation - 5 minutes Discussion A. Each student will be asked to choose one topic out of following five choices: 1. In 2008, the WHO's Commission on Social Determinants of Health published its report "Closing the gap in a generation: Health equity through action on the social determinants of health". The report argued that addressing health inequities requires redistribution of wealth, power and resources. Discuss this conclusion and develop arguments to motivate your agreement or disagreement with it. 2. The social determinants of health approach is just for inspiration and out of goodwill. It cannot be operationalized simply because we cannot measure the relation between these upstream determinants and health. Indicate whether you agree or disagree with this statement. Use examples to support your discussion. 3. The WHO constitution (1948) stated that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition". Discuss whether or not we (the nation of the US) could operationalize this principle. Support your discussion with demonstrative examples. 4. The total expenditure on health care per capita in the US is higher than any other country in the world while mortality and life expectancy reports continue to rank the US near to the bottom of the list of OECD countries. Discuss this statement, Motivate your discussion with arguments and demonstrative examples. 5. Screening for social determinates of health helps clinicians in reaching the diagnosis, developing the treatment plan. Discuss this statement and motivate your agreement or disagreement with examples. B. Presentation guidelines include: 1. Introduction to provide background to the topic and discuss its importance 2. Use systematic way while answering the selected questions; organize your arguments in a logic sequence, support these arguments with demonstrative examples from available literature, and provide a list of references. 3. Provide a concise conclusion.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Once at the end of the elective.
  B. Format - What guidelines are set for the student's written work?
    As described above, students will be given five questions; each student should choose one question to answer in a form of a short eassy (750 word max)
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
    Students will be asked to cite at least five recent references in their essay. They can use references from the readijns that faculty will offer them during the elective. In addition, the course director will have one to one discussion to guide students on selecting the references. Listed references will be in AMA style.
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Each student will select one out of five questions given by the course director to write a short eassy.
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
  Format
    Oral   Written multiple choice   Written essay / short answer   OSCE
Other

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    The course will consist of four general components: 1. Lectures: The lectures will be designed to introduce definitions, conceptual frameworks, evidence around 2. Problem-Based learning through well-designed exercises to enhance e the analytical and problem-solving capacities. 3. Readings/videos/online material - Recently published and milestone literature will be given as reading materials. We will classify them into mandatory and elective readings. 4. Community Engagement. During the course, students will be required to spend one morning or evening at one or two identified clinics (e.g., Dr Patel's clinic, Luke Society clinic). Students will also be required to visit one of the community-based organizations (CBOs) in Galveston that address some of the social determinants. Instructions for what they will do in each setting will be given on the first and second days of class, with in-class discussions. If you do not have transportation, please make arrangements with one of your classmates or the instructor to get to your required sites.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".
    None

7.  Other Modes of Evaluation
  Please explain below.
    Students will interact and meet with the course director faculty everyday during the course who will provide hands on training and one on one mentoring, interaction and feedback.
Students will be evaluated with respect to the following items:
­ Knowledge acquisition,
­ Knowledge application / problem-solving skills,
­ Group interaction, and
­ Professional behavior
Students will be also given the chance to evaluate their benefits from the course. This will be through an evaluation form to help students to document the usefulness of the course in terms of specific knowledge and skills.
In order to pass this course (expected performance) students will have to complete the following:
­ Attend all required in-class sessions.
­ Complete at least one community organization site visit.
­ Complete writing assignments.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.
   
 
B.
Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.
   
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
   
 
D.
What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?
   
 
E.
An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?
   
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
   
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
   
 
H.
Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.