背景:本科医学教育必须纳入健康的社会决定因素。然而,很少有人知道如何准备临床前的学生为现实世界的筛查和转诊,以解决健康的社会决定因素。
目的:这个试点项目的目的是评估使用真实世界的可行性,基于服务的学习方法,用于在COVID-19大流行期间(2020年5月至6月)通过电子病历培训临床前学生评估社会需求并进行相关转诊。
方法:该项目旨在解决紧急的社区服务需求,并教授临床前,二年级医学生志愿者(n=11)如何通过使用电子健康记录(EHR;Epic平台;EpicSystemsCorporation)中的10项健康筛查社会决定因素问卷来评估社会需求并进行推荐。三年级医学生志愿者(n=3),完成了6次临床轮换,领导了2小时的技能发展方向,并可用于持续的指导和同行支持。所有学生与病人的沟通都是通过电话进行的,双语(英语和西班牙语)的学生打电话给喜欢用西班牙语交流的患者。我们分析了从Epic中提取的EHR数据以评估筛查,并分析了从REDCap(研究电子数据捕获;范德比尔特大学)中提取的数据以评估社区卫生工作者的注释。我们从参与的临床前学生那里获得了反馈,以评估这种基于社区的服务学习方法在临床前课程中的未来使用。
结果:临床前学生完成了45次筛选访谈。在45名接受筛查的患者中,20人(44%)对至少1种社会需求进行了筛查。几乎所有这些患者(19/20,95%)都被转诊给社区卫生工作者。与社区卫生工作者进行咨询的患者中有一半(8/16,50%)与相关的社会服务资源有关。临床前学生表示,项目参与提高了他们评估社会需求和进行所需EHR转介的能力。粮食不安全是最常见的社会需求。
结论:实际接触社会需求评估有可能帮助临床前医学生在进入医学院三年级的临床文员之前培养解决社会问题的能力。学生也可以在进入三年级的职员之前熟悉EHR。内科医生,他们了解社会需求,并拥有采取行动所需的电子病历工具和员工资源,可以创建工作流程,使社会需求评估和服务成为医疗保健的组成部分。研究和质量改进举措需要研究如何将社会需求筛查和将患者与适当的社会服务联系起来纳入常规的初级保健程序。
BACKGROUND: The inclusion of social determinants of health is mandated for undergraduate medical education. However, little is known about how to prepare preclinical students for real-world screening and referrals for addressing social determinants of health.
OBJECTIVE: This pilot project\'s objective was to evaluate the feasibility of using a real-world, service-based learning approach for training preclinical students to assess social
needs and make relevant referrals via the electronic medical record during the COVID-19 pandemic (May to June 2020).
METHODS: This project was designed to address an acute community service need and to teach preclinical, second-year medical student volunteers (n=11) how to assess social
needs and make referrals by using the 10-item Social Determinants of Health Screening Questionnaire in the electronic health record (EHR; Epic platform; Epic Systems Corporation). Third-year medical student volunteers (n=3), who had completed 6 clinical rotations, led the 2-hour skills development orientation and were available for ongoing mentoring and peer support. All student-patient communication was conducted by telephone, and bilingual (English and Spanish) students called the patients who preferred to communicate in Spanish. We analyzed EHR data extracted from Epic to evaluate screening and data extracted from REDCap (Research Electronic Data Capture; Vanderbilt University) to evaluate community health workers\' notes. We elicited feedback from the participating preclinical students to evaluate the future use of this community-based service learning approach in our preclinical curriculum.
RESULTS: The preclinical students completed 45 screening interviews. Of the 45 screened patients, 20 (44%) screened positive for at least 1 social need. Almost all of these patients (19/20, 95%) were referred to the community health worker. Half (8/16, 50%) of the patients who had consultations with the community health worker were connected with a relevant social service resource. The preclinical students indicated that project participation increased their ability to assess social
needs and make needed EHR referrals. Food insecurity was the most common social need.
CONCLUSIONS: Practical exposure to social needs assessment has the potential to help preclinical medical students develop the ability to address social concerns prior to entering clinical clerkships in their third year of medical school. The students can also become familiar with the EHR prior to entering third-year clerkships. Physicians, who are aware of social
needs and have the electronic medical record tools and staff resources needed to act, can create workflows to make social
needs assessments and services integral components of health care. Research studies and quality improvement initiatives need to investigate how to integrate screening for social needs and connecting patients to the appropriate social services into routine primary care procedures.