Presented By: Samar Hegazy, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign
Co-Authors: Barbara Masi, Icahn Medical School at Mount Sinai
Kellie Mullany, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign
Grace Park, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign
Imanni Sheppard, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign
Jaya Yodh, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign

Purpose 
Understanding the role of social determinants of health (SDOH) in disease process and patient management is essential to high-quality health care to promote health and prevent disease. Despite the increasing interest in incorporating SDOH into medical curricula, there is no consensus on the instructional approaches to teach SDOH or assess students' learning/competencies relevant to SDOH. We introduced a novel approach to teaching SDOH and assessing relevant clinical decision-making abilities in Problem-Based Learning (PBL) using concept mapping (CM). 

Methods 
This study occurred during two PBL cases for students at Carle Illinois College of Medicine. Fourteen pre-Clerkship medical students voluntarily participated and were randomly assigned to control and experimental groups. Both groups received pre-intervention training on CM. Only the experimental group experienced linking SDOH to the disease process and treatment plans using CM and specific probes in their PBL sessions. Students in both groups completed individual post-PBL assignments of designing a treatment plan using CM and a recorded reflective narrative on the CM design based on a new clinical vignette. Concept maps were scored using a validated scoring rubric. Recorded reflections were transcribed and analyzed using inductive thematic coding. 

Results 
Quantitative data analysis demonstrated statistically significant differences (p<0.01-0.001) in concept map scores between experimental and control groups in the rubric main categories of connections and links, SDOH, disease process, and treatment plan. Qualitative data analysis comparing the experimental and control group thematic codes highlighted differences in how this curricular intervention enhanced students' sociocultural competency in designing a patient-centered treatment plan following an SDOH-informed clinical reasoning process. 

Conclusion 
This innovative curricular approach of integrating the SDOH framework in PBL using CM as an evidence-based teaching and assessment tool helped medical students visualize and reflect on integrated basic, clinical, and SDOH concepts. Additionally, it enhanced medical students' sociocultural competency in providing holistic patient-centered care.