Year: 2023
Type: article
Abstract: As medical students progress through training and build mental algorithms of disease presentations, it is essential to include considerations of social determinants of health. It is not enough for students to focus on diseases; they must be able to recognise and have tools to mitigate effects on patient health resulting from social and systemic inequities/barriers. Unfortunately, teaching about social accountability is not always consistent. We identified the family medicine clerkship as an ideal context to leverage an existing peer-teaching assignment for explicit learning about social accountability with a focus on understanding of underserved communities. Our objective was to determine whether introduction of a new rubric explicitly including social accountability was effective in encouraging students to incorporate discussion of social accountability factors into a clinical topic presentation. The family medicine clerkship uses a peer-teaching strategy where paired students summarise a case-based clinical topic using a presentation to meet clerkship objectives. The 10-min presentations were previously assessed using a rubric of transparent criteria. In 2021, the rubric was redesigned to explicitly integrate social accountability principles. Additional criteria include (1) recognition of societal and health system inequities and (2) discussion of possible solutions to societal and health system inequities. The additional criteria extended presentation time to 20 min. We conducted a conceptual content analysis of de-identified and blinded presentations. Presentations from two cohorts were included: one immediate pre-change cohort and one immediate post-change cohort. Each presentation was scored on eight elements: social (1) and societal (2) inequities; possible solutions to those inequities (3,4); patient-centred discussion of social and societal inequities (5,6) and possible solutions (7,8). For each element, mean scores were compared between pre-change (N = 60) and post-change (N = 67) presentations using independent samples t-tests. Across all elements, post-change presentations had significantly higher scores. However, standard deviation was higher on all eight themes post-change: Not all presentations incorporated all (or any) social accountability elements. We found explicitly incorporating social accountability into the assessment rubric prompted students to include social and societal inequities in their presentations, although there was some variability in effectiveness. Using a rubric to explicitly encourage students to discuss themes of social accountability may be an effective low-resource intervention for training programmes. This project showed that beyond their traditional role in transparent assessment, rubrics can be leveraged to encourage engagement in discussion of issues and concepts students may not otherwise consider, or consider only at a surface level. Using rubrics to outline expectations and explicitly highlight specific topics can result in an effective transition to a deeper level of cognition. Our rubric change acted as an invitation, a metaphor proposed by Bearman and Ajjawi1 to allow students to enter a ‘productive space’ to ‘make meaning through enacting the criteria in a holistic way’. Such a rubric change is a simple, feasible, low-cost and high-yield intervention for supporting behavioural change in medical students towards actively considering social accountability as part of comprehensive patient-centred medical care.
Source: Medical Education
DOI: 10.1111/medu.15058
Authors: Prachi Shah, Shelley Ross, Jill Konkin, Lillian Au, Ann Lee
Institution: University of Alberta
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,050
OpenAlex ID: W4322617237