An analysis of social determinants of health and structural competency training in global emergency medicine fellowship programs in the United States

Lindsay G Grossman; Oren J Mechanic; Zvika Orr; Eric C Cioe-Peña; Alden Landry; Shifra Unger; Josh Greenstein; Evan Avraham Alpert

doi:10.1002/aet2.10660

An analysis of social determinants of health and structural competency training in global emergency medicine fellowship programs in the United States

AEM Educ Train. 2021 Sep 29;5(Suppl 1):S28-S32. doi: 10.1002/aet2.10660. eCollection 2021 Sep.

Authors

Lindsay G Grossman¹, Oren J Mechanic^{2

3}, Zvika Orr⁴, Eric C Cioe-Peña⁵, Alden Landry⁶, Shifra Unger⁴, Josh Greenstein⁷, Evan Avraham Alpert⁸

Affiliations

¹ Perelman School of Medicine The University of Pennsylvania Philadelphia Pennsylvania USA.
² Harvard Medical Faculty Physicians Boston Massachusetts USA.
³ Department of Emergency Medicine Mount Sinai Medical Center Miami Beach Florida USA.
⁴ Department of Nursing Jerusalem College of Technology Jerusalem Israel.
⁵ Center for Global Health Northwell Health New Hyde Park New York USA.
⁶ Department of Emergency Medicine Beth Israel Deaconess Medical Center Boston Massachusetts USA.
⁷ Department of Emergency Medicine Northwell Staten Island University Hospital Staten Island New York USA.
⁸ Department of Emergency Medicine Shaare Zedek Medical Center Faculty of Medicine, Hebrew University of Jerusalem Jerusalem Israel.

Abstract

Background: Clinicians must be aware of the structural forces that affect their patients to appropriately address their unique health care needs. This study aimed to assess the participation of global emergency medicine (GEM) fellowship programs in formal social determinants of health (SDH) and structural competency (SC) training to evaluate the existence and procedures of such programs.

Methods: A cross-sectional study conducted with a short, online survey with questions regarding the presence of curriculum focused on SDH, SC, educational metrics, and the desire for further formal training in this domain was sent to all 25 GEM fellowship directors through the Global Emergency Medicine Fellowship Consortium (GEMFC) email listserv.

Results: Eighty percent (20/25) of GEM fellowship directors responded to the survey. All (20/20) of participating fellowship programs included SDH and SC training in their didactic curriculum, and eight of 20 (40%) programs offered similar training for faculty. Additionally, 19 of 20 (95%) of respondents indicated interest in an open-source tool for emergency medicine (EM) fellowship training in SDH and SC.

Conclusions: While multiple GEM programs offer formal training on SDH and SC, gaps exist regarding similar training for faculty. Additionally, there is a lack of metrics to determine fellows' comfort with the content of this training. As a majority of GEMFC programs requested, an open-source tool would allow a uniform curriculum and measurement of EM fellowship training in SDH and SC.