Date of Award

January 2019

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Anita Arora

Abstract

Social and economic factors have a profound impact on the health of patients served by physician residents. However, education about these factors has not been consistently incorporated into residency training. Experiential education, such as neighborhood walking tours, may help physician residents learn about the social determinants of health and community resources available to patients.

Using a community-based participatory research (CBPR) approach, we implemented a neighborhood walking tour curriculum for physician residents and faculty in the Pediatrics, OB/Gyn, Emergency Medicine, Primary Care and Traditional Medicine programs. In 2017, 86 individuals participated in the tours, 81 physician residents and 5 faculty. Both pre- and post-tour, we asked participants to rank the importance of various individual- and neighborhood-level factors affecting their patients’ health, and to describe strategies they use to improve health behaviors, their knowledge of community resources available to patients living in these neighborhoods, and how the experience might change their patient care.

Among 81 physician-residents who participated in tours in 2017, 75 completed the pre-tour survey (93% response rate) and 43 completed the post-tour survey (53%). In pre-tour surveys, respondents ranked “access to primary care” most frequently (67% of respondents) as a major factor affecting patient health. In describing ways to improve diet and exercise, 67% of respondents discussed strategies focused on the individual, compared to 16% who focused on neighborhood-level strategies. In post-tour surveys, respondents ranked “income” and “transportation” most frequently as major factors affecting patient health (44% each); in describing ways to improve diet and exercise, 39% of respondents discussed strategies focused on the individual, compared to 37% who focused on neighborhood-level. The percentage of respondents aware of community resources grew from 5% to 72% after tours.

The neighborhood walking tour experience helped physician residents recognize the importance of social determinants of health and the value of community resources. The experience also broadened their frameworks for how they might counsel patients on healthy lifestyles.

Comments

This is an Open Access Thesis.

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