Social Determinants of Health Screening by Pre-clinical Medical Students during the COVID-19 Pandemic: A Service-Based Learning Case Study (Preprint)

BACKGROUND Background: Inclusion of social determinants of health is mandated for undergraduate medical education. However, little is known about how prepare pre-clinical students for “real world” screening and referrals to address social determinants of health. OBJECTIVE The pilot project objective was to evaluate the feasibility of using “real world” service-based learning approach in training pre-clinical students to assess social needs and make relevant referrals via the electronic medical record during in COVID-19 pandemic (May-June 2020). METHODS This project was designed to address an acute community service need and to teach pre-clinical second-year medical student (n=11) volunteers how to assess social needs and make referrals using the 10-item Social Determinants of Screening Questionnaire in the electronic health record (epic platform). Third-year medical student volunteers (n= 3), who had completed six clinical rotations, led the one-day skills development orientation and were available for on-going mentoring and peer support. All student-patient communication was by telephone, and bi-lingual (English/Spanish) students called the patients, who preferred to communicate in Spanish. We analyzed EHR data extracted from epic to evaluate screening and data extracted from REDCap to evaluate community health worker notes. We elicited feedback from the participating pre-clinical students to evaluate the future use of this community-based service-learning approach in our pre-clinical curriculum. RESULTS The pre-clinical students completed 45 screening interviews; 20 patients (44%) screened positive for at least one social need. Almost all (19/20) were referred to the community health worker. Half (8/16) patients, who had community health worker consultation, were connected with a relevant social service resource. The pre-clinical students indicated that project participation increased their ability to assess social needs and to make needed electronic health record referrals. Food insecurity was the most common social needs. CONCLUSIONS Practical exposure to social needs assessment has the potential to develop pre-clinical medical students’ ability to address social concerns prior to entering clinical clerkships in their third year of medical school. The students can also become familiar with the EHR prior to entering third year clerkships. Physicians, who are aware of social needs and have EMR tools and staff resources to act, can create workflows to make social needs assessment and services integral components of health care. Research studies and quality improvement initiatives need to investigate how to integrate screening for social needs and connecting patients to the appropriate social services into routine primary care procedures. CLINICALTRIAL not a clinical trial