The Impact of See the City You Serve Fieldtrip: An Educational Tool for Teaching the Social Determinants of Health

Purpose: Despite a call to action to address the social determinants of health in the United States, there has been limited evaluation of specific tools for teaching the social determinants of health to our medical learners. This study evaluates the See the City You Serve Fieldtrip as a tool for teaching the social determinants of health to incoming medical interns. Methods: 85 incoming interns from The George Washington University School of Medicine and Health Sciences Graduate Medical Education programs participated in a bus tour of Washington, D.C. guided by community partners. The fieldtrip introduced trainees to the neighborhoods where their patients will come from. Each participant completed a pre and post activity survey. The pre and post-test values were compared for each participant using a two-sided, paired t-test. Qualitative reflection responses were recorded and coded for recurrent themes. Results: In our study population, 21% of the interns were from D.C. and 93% had experience working with underserved populations. Basic knowledge of D.C. disparities increased after the activity as compared to baseline as noted by the greater percentage of interns who correctly identified the number of D.C. wards (65% vs. 100%, p=0.000), the wards with the lowest per-capita income (46% vs. 100%, p=0.000), and the degree of cancer mortality disparities in D.C. (53% vs. 97%, p=0.000). Furthermore, as compared to baseline, post-activity a greater percentage report being at least somewhat comfortable understanding the neighborhoods from which their patients come (58% vs. 89%, p=0.000), identifying challenges to health care that affect low income patients (74% vs. 90%, p=0.001), describing community resources (29% vs. 67%, p=0.000), and referring patients to local community resources outside of GWU (25% vs. 64%, p=0.000). Interns recurrently reported that this experience would change the way they practice medicine through improved awareness of the social determinants of health, improved understanding of local resources to assist in patient care, and improved understanding of local patients’ background. Conclusion: We found that, among incoming residency interns, a brief bus tour guided by community partners during orientation week improved knowledge of local disparities, improved understanding and comfort addressing the social determinants of health, and inspired physicians to change the way they practice medicine. These sorts of experiences linking community resources and trainees can and should be woven into residency curriculum as part of ongoing resident education regarding population health and utilizing community resources to address the social determinants of health