Thursday, July 2, 2015

The effect of video simulation on resident attitude, comfort, and practice in assessing for social determinants of health

Jennifer O'Toole, MD, MEd
Cincinnati Children's Hospital Medical Center

Objective: Empathetic and culturally competent physician assessment of social determinants of health (SDH) is a key component to addressing health disparities and improving child health. This study aimed to determine the effects of a case-based, social history video simulation curriculum on resident comfort and social screening patterns during well child care.

Methods: A non-randomized controlled study of an educational intervention (video simulation curriculum) was performed. Resident surveys assessing their knowledge, comfort, and screening practices for SDH were performed before and after the intervention. A subset of both control and intervention residents were directly observed obtaining a social history using a standardized tool both pre- and post-intervention.
Results: Thirty-six residents completed the entire study. The majority of residents (72.5%) had no personal experience with social hardship. Residents who received the simulation curriculum showed a statistically significant increase during faculty observation in the amount of time they spent obtaining a social history (165 seconds, P=0.04), inquired more frequently about family supports (P=0.046) and housing conditions (P=0.045), and trended towards increased counseling and discussion of resources (P=0.08). No differences were noted between the groups on personal report of knowledge of SDH or screening practices. Fewer residents in the intervention group noted lack of time, knowledge of SDH, and discomfort as barriers to obtaining a social history following the curriculum.
Conclusions: A social history video simulation curriculum increased the time residents spent obtaining a social history and screening for a limited number of SDH. Residents also identified fewer barriers to screening following the curriculum.