Purpose: The field of medicine is becoming increasingly aware of the role that social determinants of health (SDH) play in shaping health and health outcomes. Organized medicine – including prominent physician groups and accreditation bodies – has endorsed SDH education as an integral component of medical school curricula. This study sought to describe medical student perspectives on the current state of SDH in preclinical curricula.
Methods: The authors developed a 9-item survey to assess time being spent on SDH and attitudes toward the current level of SDH content in preclinical curricula. All medical students at both campuses of a large public medical school were invited to participate between December 2019 and February 2020.
Results: Of 1010 medical students invited to participate, 515 (51.0%) responded. Of the 515 respondents, 480 (93.2%) reported spending at least 40 hours per week on medical school, and of those, 405 (84.4%) said they spend 0– 2 hours on SDH. The majority of all respondents (62.1%; 320/515) felt the current level of focus on SDH is “not enough”, while only eleven students (2.1%; 11/515) felt it is “too much”. In a multiple logistic model, Black students were over four times as likely as white students (aOR 4.19; 95% CI 1.37– 18.38) to feel the current level of focus on SDH is “not enough”. Likewise, women were 2.3-times (aOR 2.30; 95% CI 1.52– 3.49) as likely as men to feel the level of focus on SDH is “not enough”.
Conclusion: In practice, medical students are spending considerably less time learning SDH than is advised by consensus of expert educators and administrators. Over sixty percent of medical students do not feel the current level of focus on SDH is sufficient. Further study is needed to determine why women and racial minority students are significantly more likely to feel this way.

Keywords: social determinants of health, race/ethnicity, medical education, undergraduate medical education, undergraduate medical curriculum, social medicine, medical school, preclinical curriculum

中文翻译：

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医学生对健康教育社会决定因素的看法中的种族和性别差异：单机构调查研究

目的：医学领域越来越意识到健康社会决定因素 (SDH) 在塑造健康和健康结果方面所发挥的作用。有组织的医学——包括著名的医生团体和认证机构——已认可 SDH 教育作为医学院课程的一个组成部分。本研究旨在描述医学生对临床前课程中 SDH 现状的看法。
方法：作者开展了一项包含 9 项的调查，以评估花在 SDH 上的时间以及对临床前课程中 SDH 内容当前水平的态度。2019 年 12 月至 2020 年 2 月期间，一所大型公立医学院两个校区的所有医学生都被邀请参加。
结果：在受邀参加的 1010 名医学生中，有 515 名 (51.0%) 做出了回应。在 515 名受访者中，480 人 (93.2%) 表示每周至少在医学院花费 40 小时，其中 405 人 (84.4%) 表示他们在 SDH 上花费 0-2 小时。大多数受访者（62.1%；320/515）认为目前对 SDH 的关注程度“不够”，而只有 11 名学生（2.1%；11/515）认为“太多”。在多重逻辑模型中，黑人学生认为当前对 SDH 的关注程度“不够”的可能性是白人学生的四倍多（aOR 4.19；95% CI 1.37-18.38）。同样，女性认为对 SDH 的关注程度“不够”的可能性是男性的 2.3 倍（aOR 2.30；95% CI 1.52-3.49）。
结论：在实践中，医学生学习 SDH 的时间比教育专家和管理人员一致建议的时间要少得多。超过 60% 的医学生认为目前对 SDH 的关注程度还不够。需要进一步研究来确定为什么女性和少数族裔学生更有可能有这种感觉。

关键词：健康的社会决定因素、种族/族裔、医学教育、本科医学教育、本科医学课程、社会医学、医学院、临床前课程