Consider the root of the problem: increasing trainee skills at assessing and addressing social determinants of health

Autor: Jayme Mejia, Shawna M. Sisler, Andrea S. Wallace, Linda M. Stephan, Naomi A. Schapiro
Rok vydání: 2019
Předmět:
medicine.medical_specialty
Adolescent
Social Determinants of Health
Clinical Sciences
Oncology and Carcinogenesis
Population
Social Determinants of Health & Healthcare
030209 endocrinology & metabolism
Translational research
Nursing
Social needs
Adolescents
Pediatrics
Education
03 medical and health sciences
Behavioral Neuroscience
0302 clinical medicine
Clinical Research
medicine
Training
Humans
Nurse Practitioners
030212 general & internal medicine
Social determinants of health
Students
Education
Nursing
education
Qualitative Research
Applied Psychology
Pediatric
education.field_of_study
Standardized patients
Self Efficacy
Patient Simulation
Good Health and Well Being
Social history (medicine)
Family medicine
Cohort
Female
Students
Nursing
Clinical Competence
Thematic analysis
Psychology
Psychosocial
Simulation
Qualitative research
Zdroj: Transl Behav Med
Translational behavioral medicine, vol 9, iss 3
ISSN: 1613-9860
1869-6716
Popis: National pediatrics guidelines recommend screening all patients for unmet social needs to improve self-management of chronic conditions and health outcomes and to reduce costs. Practitioners involved in training pediatric clinicians need to understand how to prepare pediatric clinicians to effectively conduct social needs screening and where current training methods fall short. Our qualitative study investigated whether using "standardized" patients during trainee education improved trainees' ability to assess and address adolescent patients' social needs. Vulnerable adolescents should be prioritized in social determinants of health translational research because increased risk taking and emotionality may predispose this population to lower self-esteem and self-efficacy. We trained 23 adolescents (aged 16-18) recruited from an urban health-career education program to act as standardized patients (SPs). Two cohorts of nurse practitioner trainees (n = 36) enrolled in a simulation where the patient-actor presented with a minor chief complaint and related a fabricated complex social history. Pre-encounter, Cohort 1 (n = 18) reviewed psychosocial screeners; Cohort 2 (n = 18) were given in-depth information about social needs before meeting patients. SPs gave individualized feedback to trainees, and self-reflections were analyzed using thematic analysis. In Cohort 1, trainees identified some social needs, yet few intervened. Trainees expressed discomfort in: (a) asking socially sensitive questions and (b) triaging patient versus clinician priorities. Cohort 2 demonstrated improvements compared to Cohort 1 in identifying needs yet had similar difficulty with organization and questioning. Trainees were able to utilize a lower-stakes interaction with patient-actors to raise awareness regarding a patient's sensitive needs and to organize care surrounding these patient-centered concerns.
Databáze: OpenAIRE
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