PC3104: Thematic Analysis of Third-year Medical Student Reflections on Social Determinants of Health During Their Pediatric Clerkship: Emergent Themes and Topic Interconnectedness

Background: Social determinants of health (SDOH), as defined by the World Health Organization, are the “non-medical factors that influence health outcomes… the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” Studies have estimated that SDOH account for 30-55% of health outcomes. Understanding the impact of SDOH can be integrated into medical education in different formats, here we explore student reflections.

Methods: In the 2021-2022 academic year, third-year medical students at a midwestern medical school submitted discussion board reflections on their experiences with SDOH during their 8-week pediatric clerkship. We analyzed de-identified posts to look for emergent themes that showcase the experiences and perceptions of medical students as they care for patients and learn about the socio-environmental factors in the community. Initial coding was built on a preliminary codebook drafted based on the medical school’s SDOH curriculum. Utilizing a grounded theory approach, we added new codes as novel topics and themes emerged. We then examined the relationships between the codes and SDOH categories outlined in the US Department of Health and Human Services Healthy People 2030 objectives. During our secondary analysis, we coded these responses within a social ecological context to explore the level of societal relationships that students perceive.

Results: Ninety-seven student discussion posts were analyzed. Our preliminary results demonstrate the two most common themes, social support and communication, together represented approximately 50% of all student responses. With the addition of the next two most frequently discussed topics, healthcare access and diet/nutrition, this set of themes comprises over 75% of student responses (Figure 1). Student responses also demonstrated the interconnectedness of SDOH categories through frequent overlap of categories during coding and analysis (Figure 2). Our secondary analysis of 34 discussion posts revealed varying depth within a social ecological framework, with most students discussing community or societal-level factors.

Conclusion: Our study demonstrates the most common SDOH themes students identified during the pediatric clerkship involve social support, communication, access to care, and diet/nutrition. We found a multifactorial, connected nature of those themes as they impact patient health. Many students identify community-level factors that impact patient health within a social ecological framework. This study validates the need for explicit education on SDOH topics during medical school so that future physicians are well-equipped to intervene or accommodate these factors throughout their careers.