Using Case-based Team Training to Introduce the Social Determinants of Health

Background

Interprofessional team-based training (IPTT) promotes positive attitudes towards working in IP teams and helps to create a “collaborative practice-ready” healthcare workforce. The challenge is to integrate IPTT learning experiences into university-wide clinical courses to cross all four IP collaborative competency sub-domains (IP values/ethics, recognition of roles and responsibilities, effective IP communication and teamwork) while also introducing participants to the concepts of the Social Determinants of Health (SDOH).

Design

Building on earlier versions of our IPTT activity we devised a new maternal/child case study underpinned by the SDOH and interprofessional teams of learners (n = 271) were guided through a 3-step team-based experience. Step 1: Learners from nine professions viewed a video interview with the mother and daughter where they described the clinical, financial and social conditions they were experiencing. Step 2: IP faculty facilitated small groups (~11-25 learners/group) to develop a care plan using data collected in step 1. Medical, emotional, social, environmental and economic problems were prioritized for treatment. Step 3: Groups reflected on professional values and personal attitudes towards working in IP teams. Learner competencies were evaluated using the Interprofessional Collaborative Competency Attainment Scale (Revised) (ICCAS) (McDonald et al). Participants also provided written feedback about their experience of the activity.

Results

On a five point Likert scale learners demonstrated improvement in IP skill on all ICCAS items. The greatest increase was for ability to “understand the abilities and contributions of IP team members”. Learners also provided qualitative feedback on the activity, including: "Really enjoyed the case and working with other specialties; “This was one of the first times collaborating with all the other professions. Amazing”.

Conclusion

Underpinning the case with SODH engaged leaners in factors beyond the clinical case that need to be considered when treating a patient. This emphasized the role of social work and public health professions in providing a holistic solution to meet patient centered goals and improve patient outcomes.

Lessons Learned

Learners were open to using the SODH as part of their care planning. Many had not previously considered how these factors affected the feasibility of their solutions for the patient. Introducing the SODH made them consider the situation more holistically to provide a plan that the family could implement.