Social and economic factors have a profound impact on patient health. However, education about these factors has been inconsistently incorporated into residency training. Neighbourhood walking tours may help physician-residents learn about the social determinants of health (SDoH). We assessed the impact of a neighbourhood walking tour on physician-residents’ perceptions of SDoH, plans for counselling patients and knowledge of community resources. Using a community-based participatory research approach, in 2017 we implemented a neighbourhood walking tour curriculum for physician-residents in internal medicine, internal medicine/primary care, emergency medicine, paediatrics, combined internal medicine/paediatrics and obstetrics/gynaecology. In both pre-tour and post-tour, we asked participants to (1) rank the importance of individual-level and neighbourhood-level factors affecting patients’ health, (2) describe strategies used to improve health behaviours and (3) describe knowledge of community resources. Eighty-one physician-residents participated in walks (pre-tour surveys (93% participation rate (n=75)), and post-tour surveys (53% participation rate (n=43)). Pre-tour, the factor ranked most frequently affecting patient health was ‘access to primary care’ (67%) compared with post-tour: ‘income’ (44%) and ‘transportation’ (44%). In describing ways to improve diet and exercise, among pre-tour survey respondents, 67% discussed individual-level strategies and 16% discussed neighbourhood-level, while among post-tour survey respondents, 39% of respondents discussed individual-level strategies and 37% discussed neighbourhood-level. Percentage of respondents aware of community resources changed from 5% to 76% (p<0.001). Walking tours helped physician-residents recognise the importance of SDoH and the value of community resources, and may have broadened frameworks for counselling patients on healthy lifestyles.
- medical education & training
- public health
- social medicine
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Presented at Prior poster presentation: Cross JJ, Arora A, Boatright D, Vijayakumar P, Cruz L, Smart J, Spell V, Greene A, Berg D, Rosenthal M. Neighbourhood Walking Tours for Physicians-in-Training. Society for General Internal Medicine National Meeting 2018.
Contributors JJC planned the study, distributed surveys, collected data, analysed data, compiled the manuscript, and was responsible for the overall content as guarantor. AA planned the study, collected data, analysed data and edited the manuscript. BH planned the study, collected data, analysed data and edited the manuscript. DB planned the study and edited the manuscript. PV distributed surveys, collected data and edited the manuscript. LC assisted in designing the tour curriculum and planning the tours and led tours. JS and VS assisted in designing the tour curriculum and planning the tours, and led tours. AG planned the study. MR planned the study and edited the manuscript.
Funding This study was funded by Department of Internal Medicine, Yale School of Medicine Department of Emergency Medicine, Yale School of Medicine Department of Pediatrics, Yale School of Medicine Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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