Pre-clerkship Pediatric Exposure Enhances Understanding of Social Determinants of Health

Abstract

The Child and Adolescent Motivation and Enrichment Program (CHAMP), an initiative pairing pre-clerkship medical students with pediatric patients undergoing hemodialysis (HD), provides support to HD patients while also providing medical students with opportunities to increase their comfort in the clinical environment and awareness of social determinants of health (SDH).

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-021-01329-4.

Social determinants of health (SDH) are non-medical factors, including economic and social factors, which can greatly impact health. The Association of American Medical Colleges has included SDH as a social science competency for medical students [1]. One service-learning program aimed at training medical students on SDH was found to enhance student-reported understanding of and ability to develop interventions for SDH [2]. Further, pre-clerkship pediatric experiences have been correlated with increased comfort interacting with pediatric patients and their families [3]. Despite this, pediatric clinical experiences focused on understanding SDH are rarely incorporated into the pre-clerkship curriculum. The Child and Adolescent Motivation and Enrichment Program (CHAMP) pairs first-year medical student mentors with pediatric patients undergoing hemodialysis (HD) for weekly sessions aimed at enhancing literacy, health literacy, and social support [4]. Mentors utilize educational materials including electronic tablets and worksheets to mitigate the effects of chronic school absenteeism and support the educational needs of HD patients. In addition to important benefits for participating patients, CHAMP provides pre-clerkship pediatric exposure and career guidance to medical students through meaningful volunteer and educational opportunities, including shadowing and research experiences. Additionally, participating medical students gain valuable exposure to patients coping with chronic illness which serves to promote improved knowledge and understanding of SDH and comfort interacting with patients in the clinical setting. In our program, medical students who elected to serve as mentors through CHAMP underwent two separate 1-h didactic training sessions detailing the healthcare and nutritional needs of patients with chronic kidney disease (CKD), key SDH affecting CKD patients, and the psychosocial impact of HD on pediatric patients. Students also received training on barriers to renal transplantation, including SDH and reduced health literacy. The goal of this training was to improve overall CKD knowledge and therefore foster improved ability in patient counseling. After these sessions, mentors began volunteering during weekly 1-h sessions.

We evaluated CHAMP mentors regarding their level of self-confidence on a 5-point Likert scale (5 = strongly agree, 3 = neutral, and 1 = strongly disagree) in pre- and post-test surveys. Surveys assessed their perceived comfort working with patients with chronic health needs, knowledge of CKD and SDH, and ability to address SDH. Mentors created a unique, de-identified code so that their progress could be monitored from pre- to post-assessment. Pre-tests were completed prior to the initiation of didactic training, while post-tests were completed after 6 months of involvement with CHAMP. Of the 18 participating mentors, 12 mentors completed both the pre- and post-assessment. Paired Student’s t-tests were used to evaluate mentor progress with p < 0.05 utilized to define statistical significance. After 6 months of volunteering, 70% of mentors strongly agreed that CHAMP helped them feel more comfortable working with pediatric patients in the clinical setting, and 65% of mentors strongly agreed that CHAMP enhanced their education. There was a significant increase in mentor reported awareness of SDH that impact CKD patients from prior (2.83 ± 0.7) compared to after (3.92 ± 0.29) volunteering (t (11) = 5.61, p ≤ 0.0001). Further, 75% of mentors agreed or strongly agreed that they were able to address some of the SDH that impacted their mentee. There was also a significant increase in mentor understanding of CKD from prior (2.33 ± 0.65) compared to after (2.92 ± 0.90) volunteering (t (11) = 2.24, p = 0.046 (Fig. 1)). Finally, there was a significant increase in the number of students who correctly identified a high potassium food item before (36% of students) versus after (83% of students) volunteering (p = 0.002). On post assessment, 40% of mentors agreed or strongly agreed that they were able to counsel their patient on nutrition and/or medial compliance. Finally, 45% of mentors reported shadowing a pediatric nephrologist through CHAMP during their time as a volunteer.

Fig. 1.

There was a significant increase in mentor understanding of CKD prior to (2.33 ± .65) and after volunteering (2.92 ± .90), t (11) = 2.24, p = .046. There was also a significant increase in mentor reported awareness of SDH that impacts CKD patients prior to (2.83 ± 0.7) and after volunteering (3.92 ± 0.29), t (11) = 5.21, p = .0002

The results of our study suggest that CHAMP provides medical students with meaningful pre-clerkship pediatric exposure, which increases their comfort in the clinical environment and enhances their educational experience, particularly pertaining to knowledge of SDH and CKD. The CHAMP provides medical students with invaluable opportunities to counsel patients on SDH and nutrition, while individually addressing health literacy and the psychosocial impact of HD. Planned future expansion of the program includes additional educational opportunities for mentors regarding topics relating to CKD such as the pathophysiology, management, and psychological impact on patients. In addition, future longitudinal research will examine the impact of CHAMP on clerkship success and specialty interest and selection. Replication of CHAMP and similar pre-clerkship pediatric service-learning programs at additional medical schools would magnify and reaffirm the program’s benefits.

Supplementary Information

Below is the link to the electronic supplementary material.

Declarations

Conflict of interest

The authors declare no competing interests.