Social Factors of Health Care: a Thematic Analysis of First and Second Year Medical Student Reflections

Background: Addressing health disparities is necessary to ensure appropriate care for patients. This study examined the impact of Clinical Week experiences on students' recognition of social determinants of health early in their medical education.

Methods: A 5-day experience each of the first three semesters of medical school provided direct patient care experiences. Two Clinical Weeks were spent in outpatient clinics located primarily in rural areas. Students completed a reflective writing assignment about their experiences after each 5-day experience. Ninety-two reflections during AY 2018-2019 included discussions about social determinants of health. Two investigators analyzed these essays independently using narrative inquiry techniques. After inductive coding was complete, researchers discussed themes and their broader meaning.

Results: Themes emerged related to health disparities experienced by rural communities, minority populations, and both uninsured and underinsured patients. Reflections emphasized a lack of public accommodations in rural settings, such as public transportation and access to healthy food. Students noted how ethnic, cultural, and linguistic identity affect a patient's experience with healthcare. Other themes involved the challenges patients face affording treatment plans and conversely how health status can impact economic stability. Finally, students emphasized the importance of physician advocacy in overcoming such barriers to quality health care.

Conclusions: Although not the emphasis of Clinical Week, students' reflections identified critical social issues impacting the health of patients they encountered. This experience could be adapted at other institutions.