BACKGROUND Up to 60% of preventable mortality is attributable to social determinants of health (SDOH), yet training on SDOH competencies is not widely implemented in residency. The objective of this study was to assess internal and family medicine residents' competence at identifying and addressing SDOH. METHODS Residents' perceived competence at identifying, discussing, and addressing SDOH in outpatient settings was assessed using a single questionnaire administered in March 2017. In this cross-sectional analysis, bivariate associations of resident characteristics with the following outcomes were examined: identifying, discussing, and addressing patients' challenges related to SDOH through referrals. RESULTS The survey was completed by 129 (84%) residents. Twenty residents (16%) reported an annual income of less than $50,000 during childhood. Overall, 108 residents (84%) reported previous SDOH training. Two-thirds had outpatient practices in Veterans Affairs or safety-net clinics. Thirty-nine (30%) intended to pursue a career in primary care. The following numbers of residents reported high levels of competence for performing these outcomes: identifying patients' challenges related to SDOH: 37 (29%); discussing them with patients: 18 (14%); and addressing these challenges through referrals to internal and external resources: 13 (10%) and 11 (9%), respectively. Factors associated with higher competence included older age, lower childhood household income, prior education about SDOH, primary practice site and intention to practice primary care. CONCLUSIONS Most residents had previous SDOH training, yet only a small proportion of residents reported being highly competent at identifying or addressing SDOH. Providing opportunities for practical training may be a key component in preparing medical residents to identify and address SDOH effectively in outpatient practice.

中文翻译：

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识别和解决门诊实践中健康的社会决定因素：内部和家庭医学居民全计划调查的结果。

背景技术高达60％的可预防死亡率可归因于健康的社会决定因素（SDOH），但是，住院医生中并未广泛实施关于SDOH能力的培训。这项研究的目的是评估居民和家庭医学居民识别和解决SDOH的能力。方法采用2017年3月发布的单份问卷评估了居民在门诊环境中识别，讨论和解决SDOH的感知能力。在此横断面分析中，研究了居民特征与以下结果的双变量关联：识别，讨论，并通过转诊解决患者与SDOH相关的挑战。结果这项调查由129（84％）位居民完成。20位居民（16％）报告的年收入低于50美元，在儿童时期000。总体而言，有108位居民（84％）报告了先前的SDOH培训。三分之二的人在退伍军人事务或安全网诊所就诊。三十九（30％）人打算从事初级保健工作。下列居民报告称执行这些结果的能力很高：识别患者与SDOH相关的挑战：37（29％）；与患者讨论：18（14％）；并通过引用内部和外部资源来应对这些挑战：分别为13（10％）和11（9％）。与较高能力相关的因素包括年龄较大，儿童家庭收入较低，对SDOH的先前教育，主要执业地点和实行初级保健的意愿。结论大多数居民以前都接受过SDOH培训，但是，只有一小部分居民报告说他们具有识别或解决SDOH的能力。提供实践培训的机会可能是使医疗居民在门诊实践中有效识别和解决SDOH的关键要素。