Structural Competency Curriculum A novel approach in medical

Structural Competency Curriculum: A novel approach in medical school education for addressing the impact of upstream structural issues on patient health and health care delivery Alejandro Aviña-Cadena MS 4, Alexa Lucas MS 4, Mahan Naeim MS 2, Caroline Nore MS 2, Ifunanyachukwu Okwuosa MS 2, Gabriel Sudario MD, Alisa Wray MD, MAEd, Sangeeta Sakaria MD, MPH, MST

Disclosures We have no financial conflicts of interest to disclose

Background Doobay-Persaud (2019) 1. 2. Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017 Apr 8; 389(10077): 1453 -1463. doi: 10. 1016/S 0140 -6736(17)30569 -X. PMID: 28402827. Doobay-Persaud, A. , Adler, M. D. , Bartell, T. R. et al. Teaching the Social Determinants of Health in Undergraduate Medical Education: a Scoping Review. J GEN INTERN MED 34, 720– 730 (2019). https: //doi. org/10. 1007/s 11606 -019 -04876 -0

Purpose To develop a 4 -year longitudinal curriculum intentionally addressing structural issues within our current healthcare system. We are utilizing the NIMHD framework to focus on the healthcare system domain within the interpersonal level of influence to make an impact in the healthcare system, with the goal of improving health outcomes. Our hopes are to create a comprehensive medical education curriculum for UC Irvine School of Medicine, leaving it a better place than when we matriculated so that future students can utilize these adaptations to the curriculum as a platform from which they can feel welcomed, feel heard, and thrive.

Methods MS 1 Clinical Foundations 1 - Patient Cases - Patient Scripts - Powerpoint Slides - Lectures - Introduction to Social Determinants of Health (Aug 2020) - Introduction to Vulnerable Population (Jan 2021)

Methods MS 2 Clinical Foundations 2 - Patient Cases - Patient Scripts - Powerpoint Slides - Lectures - COVID 19 Racial and Health Inequities: Unmasking Structural Violence (Nov 2020)

Methods MS 4 Emergency Medicine Clerkship Adapted from Moffett, S. E et. al. Social Determinants of Health Curriculum Integrated Into a Core Emergency Medicine Clerkship. (Rutgers New Jersey Medical School/University Hospital —Newark) Overview: - Patient Interview - Interdisciplinary collaboration - Reflective essay 2 Week Elective vs 4 Week Sub-Internship - Infographic Honors requirement only for 2 week required rotation

Results MS 1 Introduction to Social Determinants of Health Lecture 97% of students strongly agreed or agreed the session was effective “pushes us to do/be better” “very important and needs to continue to be addressed. . . we, as future physicians, should be aware of what our patients are facing. ” MS 2 & MS 3 Currently being implemented, pending student evaluations MS 4 15 students responded to initial feedback survey 100% were very satisfied, slightly satisfied, or satisfied 87% stated, they were “more confident in identifying social determinants of health in other specialties. ”

Future Directions MS 1 & MS 2 MS 3 Review & improve powerpoint slides Review patient scripts to make sure new patient story is consistent throughout entire script Sent surveys to Clerkship Directors regarding how each clerkship is addressing specific social determinants of health - Lecture Attending champion Overall: Curriculum Audit underway MS 4 Debrief session Infographic for 4 -week Sub-Internships

References Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017 Apr 8; 389(10077): 1453 -1463. doi: 10. 1016/S 0140 -6736(17)30569 -X. PMID: 28402827. Doobay-Persaud, A. , Adler, M. D. , Bartell, T. R. et al. Teaching the Social Determinants of Health in Undergraduate Medical Education: a Scoping Review. J GEN INTERN MED 34, 720– 730 (2019). https: //doi. org/10. 1007/s 11606 -019 -04876 -0 Moffett, S. E. , Shahidi, H. , Sule, H. , & Lamba, S. (2019). Social Determinants of Health Curriculum Integrated Into a Core Emergency Medicine Clerkship. Med. Ed. PORTAL, 15(1). https: //doi. org/10. 15766/mep_2374 -8265. 10789 NIMHD Research Framework. (2021). NIMHD. https: //www. nimhd. nih. gov/about/overview/research-framework/nimhd-framework. html

Thank you! Questions? Alejandro Aviña-Cadena, MS 4 Alexa Lucas, MS 4 aavina 1@uci. edu lucasan@uci. edu