Medical student reflections on social determinants of health in the pediatric clerkship: thematic analysis and novel application of social ecological theory

Abstract Background The World Health Organization defines social determinants of health (SDOH) as the “non-medical factors that influence health outcomes… the conditions in which people are born, grow, work, live, and age…” Studies have consistently shown that SDOH have a significant impact on health outcomes. It is crucial that medical trainees understand these concepts well, yet we do not currently have a reliable method to assess student learning. Methods From April 2021 through January 2022, third-year medical students submitted discussion board reflections on their clinical experiences with SDOH during their pediatric clerkship. The prompt required students propose interventions to improve patient outcomes. These written reflections on socio-economic and environmental factors in the community and their effects on patients were evaluated via inductive thematic analysis. We then performed deductive analysis of the codes using SDOH domains outlined in the US Department of Health and Human Services Healthy People 2030 objectives. During our secondary analysis, we coded these responses within an adapted social ecological framework to explore the level of societal interventions recommended by students. Results Ninety-seven student discussion posts were analyzed and demonstrated the most common SDOH themes identified were social support and communication. It also showed that students appreciated the multifactorial, interconnected nature of SDOH through frequent overlap of themes. The secondary analysis revealed students generated interventions at varying degrees of impact within a social ecological framework. Conclusions This study explores the SDOH themes students identify and reflect on from their experience in the clinical learning environment. Information gained from this study may be used to inform medical education on SDOH topics in future curricula. Additionally, we demonstrate a novel utilization of the social ecological framework as a surrogate gauge of depth of understanding of SDOH interventions, which may hold promise as a potential educational tool for understanding of these topics.