Feasibility of an Advocacy and Social Determinants of Health Pre-orientation Experience for Pediatric Residents

Background: Marginalized groups and groups facing discrimination and racism experience numerous health disparities, leading to poor health outcomes. Graduate medical education has recognized the importance of equipping physicians to deal with social determinants of health (SDH). However, because of the variable training on SDH at the undergraduate medical level, pediatric first year residents may have differing capacities to address SDH as they enter residency. Dedicated curricular interventions have demonstrated effectiveness at the medical school level in improving trainee ability to identify SDH, though such programs do not appear to have been implemented to the same degree in residency programs to date.

Methods: Participants enrolled in the study were incoming pediatric interns at Lurie Children’s Hospital (LCH), a large tertiary-care children’s hospital in Chicago. Curriculum development was influenced by Thomas, Kern, Hughes and Chen’s six-step approach. A targeted needs assessment was conducted to understand the baseline knowledge and competence of incoming residents to address SDH and engage in advocacy. Using these results, a two-day optional pre-orientation program was developed to expose the incoming residents to major SDH in the community served at LCH through a series of lectures, discussions, and community-service projects. The orientation took place in June 2021. A program evaluation survey was distributed to the incoming residents following participation.

Results: Of the incoming residency cohort (n=34), 26 incoming residents completed the targeted needs assessment (76.5% response rate). Residents indicated varying levels of prior training and knowledge regarding SDH (Figure 1). All incoming residents indicated they want to learn more about SDH during residency (n=26/26) and most indicated a desire to learn more about advocacy (96.2%, n=25/26). Despite the pre-orientation program being marketed as optional and unpaid, 25 residents participated in one or both days of the optional pre-orientation program (a 73.5% participation rate). Interns participated in a total of 8 lectures/seminars and 2 unique volunteer experiences with community partners.

Conclusion: Incoming pediatric residents enter residency with a varying degree of knowledge to assess SDH and are eager to learn more about SDH and advocacy in their residency training. An immersive pre-orientation program is a feasible and valuable avenue to expose residents to SDH in their community and equip them with knowledge and resources to address SDH from the very beginning of their new careers as physicians. Critical to program success was institutional support from key stakeholders, including program leadership and chief residents. Additionally, intentional representation of underrepresented-in-medicine speakers was a key priority. Future directions include understanding whether a pre-orientation program can have a sustainable impact on pediatric residents' knowledge and potential expansion of the program to other pediatric residency programs.