Dear Editor,
We thank Doobay-Persaud et al.1 for their review of Social Determinants of Health (SDH) teaching in Undergraduate Medical Education in North America. We believe this to be a crucial element of good medical practice and agree it is essential to introduce at the undergraduate level.
This review evaluates the teaching practices of North American medical schools who have published their undergraduate curriculum on SDH. Although the authors find relevant published data to be scarce, an absence of published data does not necessarily correlate with an absence of SDH teaching. Indeed, many universities may not publish the contents of their undergraduate curriculum.
As medical students at the University of Dundee, Scotland, UK, we participate in longitudinal community contact in the form of a ‘Patient Journey’, where year 1 students are assigned a patient in the community to review on an annual basis. This affords the opportunity to gain a patient’s perspective of our healthcare system and barriers they face accessing care. Many of the patients volunteering to take part in this program come from deprived living situations.
SDH teaching is then revisited during an urban general practice (family medicine) rotation taken during our second last year of study. During this rotation, SDH is addressed through (a) an online eLearning module, (b) production of a poster discussing a deprivation case-study and (c) peer review and evaluation of these cases. Moreover, social deprivation has been studied extensively in Scotland, resulting in the production of the Scottish Index of Multiple Deprivation (SIMD) which aims to identify those living in the most deprived areas.2 We are required to refer to the SIMD in the context of our case study in order to illustrate the level of deprivation faced by our patient. Thus, we find SDH teaching to be a longitudinal theme, encountering deprivation at multiple stages of our training.
Sincerely,
Abbie Dunn
School of Medicine, University of Dundee
Scott C. Mackenzie
School of Medicine, University of Dundee
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Conflict of Interest
The authors declare that they do not have a conflict of interest.
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References
- 1.Doobay-Persaud A, Adler MD, Bartell TR, Sheneman NE, Martinez MD, Mangold KA, Smith P, Sheehan KM. Teaching the Social Determinants of Health in Undergraduate Medical Education: A Scoping Review. Journal of General Internal Medicine. 2019;34(5):720–30. doi: 10.1007/s11606-019-04876-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.The Scottish Government. Scottish Index of Multiple Deprivation 2016. http://simd.scot/2016/#/simd2016/BTTTFTT/9/-4.0000/55.9000/ (accessed 1 June 2019).