Shivatej Dubbaka1, Taylor Lentz1
doi: http://dx.doi.org/10.5195/ijms.2024.2194
Volume 12, Number 1: 109-111
Received 28 07 2023; Rev-request 10 09 2023; Rev-recd 24 09 2023; Accepted 20 11 2023
When faced with the heavy focus placed by most medical schools on academic studies in preclinical years, it can be challenging for medical students to branch out and search for areas in healthcare that lack support. Becoming involved in community care can help students understand social determinants of health: non-medical factors like income and education that strongly influence health outcomes. These determinants can range from environmental hazards to transportation accessibility, and all play an impact on the distribution of healthcare in society.
As part of the Physician and Society course at the University of Cincinnati College of Medicine, students are paired with community partners to identify and approach a problem from a healthcare perspective. Our student group was partnered with the Cincinnati Homeless Coalition, an organization focused on eradicating homelessness in the city through offering services, educating the community, and advocating for policy change.
As a first-year medical student weeks into my medical education, I wondered why my school was abruptly throwing me into an experience outside of the classroom. I contemplated if our time would be better spent preparing for the rigor of preclinical coursework. The following piece shares my experience understanding social determinants by building a relationship with a community partner, and how similar experiences can benefit medical students in every community. The piece follows my experience with the Cincinnati Homeless Coalition, working on a project to bring awareness and gain support for a fund to combat homelessness in Cincinnati. It also includes personal reflection and discusses how this experience impacted my early career in medicine.
Before our group could develop a project, we needed to understand the goals of the Cincinnati Homeless Coalition to identify an issue pertinent to their ongoing efforts. Our first two meetings were simply conversations with staff at the Coalition, all of whom had empowering background stories that led them to dedicate their life to serving those experiencing homelessness.
Listening to the first-hand accounts of individuals facing homelessness gave me insight into the everyday struggles hundreds of thousands of Americans face. However, I still lacked a full understanding of its connection to healthcare, but the final staff member who spoke with us changed my outlook completely.
Like the other staff members, she has faced homelessness throughout her life - living on the streets, in abandoned buildings, and even in shelters run by the Coalition. She explained how her partner had diabetes but did not have access to a primary care physician. He instead relied on infrequently offered free medical clinics with no continuity or relationship building between physicians and their patients. Today, while she dedicates much of her time to helping the Coalition, she continues to face housing and healthcare insecurity. Upon hearing this, I recognized social determinants are possibly the most crucial factors contributing to health disparities throughout the world.
Our group reflected on this first encounter and wanted to learn more about how housing insecurity can negatively impact health. In addition, we began to think about how we could apply our research to a project that could directly benefit the Coalition and its mission.
As a group, we wanted to conduct a secondary literature search into the relationship between homelessness and inadequate healthcare. We decided to examine several variables such as redlining, lack of green space access, lack of health insurance, lack of access to quality food, etc. Using these keywords and pairing them with “impact on healthcare,” we used databases such as PubMed and Google Scholar to find these relationships. One example we came across was that many individuals who face homelessness lack access to reliable transportation, a necessity that causes delays in healthcare1. This can be harmful for both those with exacerbations of chronic disease and those who have more acute medical needs.
Now recognizing the impact homelessness often has on individual health outcomes, we wanted to bring awareness to this relationship. Our original project idea involved distributing a brochure around the University of Cincinnati undergraduate campus which included information about both the Coalition's efforts and ways to get involved with their organization. However, we felt we could make an even larger impact by raising awareness within the healthcare community. We decided to host a presentation in the medical school which covered the Coalition's efforts and their connection to the healthcare needs of the community.
The presentation consisted of an informational session followed by a panel discussion. We focused on highlighting the importance of supporting the Affordable Housing Trust, which is a fund that looks to increase access to affordable housing through the construction and preservation of affordable housing units. We also emphasized the negative impact of housing insecurity on individual and community healthcare outcomes. The panel discussion consisted of Coalition leaders who answered questions from the audience. We decided to give participants a survey before and after the event to understand its impact on them. The survey included questions such as “On a scale of 1-5, how much do you know about the housing crisis in Cincinnati”, and asked the same questions after the presentation to see if there was a change. Overall, the survey revealed an increase in attendees' knowledge and awareness of the role homelessness plays in healthcare outcomes. These survey results showed that the public could learn and benefit from similar seminars that raise awareness.
While our project had many successful aspects to it, we also faced some challenges. One challenge we faced was deciding who our target audience would be for our presentation and how we would encourage them to attend. We decided we should target multiple audiences, so we had an email sent to everyone on the Coalition's weekly email list, as well as to staff at the University of Cincinnati College of Medicine. It was initially difficult to contact the administration, but after continued communication throughout the semester, we distributed the invitation.
My experience with the Cincinnati Homeless Coalition is just one example of the small steps medical students can take to become involved with their community. While focusing on academics in preclinical years is important, this experience allowed me to understand why I am dedicating my time to these studies: to apply what I have learned to help those in need in my community.
Figure 1Flow chart depicting stages of project development, from conception to implementation. After establishing a relationship with an assigned community partner, we worked to understand their goals and create a project that bridged the gap between that goal and healthcare disparities faced in that community.
Medical students should be encouraged to take part in service projects in their locality to gain firsthand experience with different social determinants of health. Our project was shared with classmates at the annual Learning Community Poster Symposium along with the diverse projects our peers were involved in, covering a wide range of these determinants.
Many studies show that encouraging relationships between medical students and community partners can result in positive changes in the health outcomes of a community2. In addition, community partnerships with medical schools have been shown to influence both the medical specialty students pursue and the location they choose to establish a practice3. In a study done on understanding medical student experiences with community partners, researchers found that long-term relationships with partners resulted in understanding community issues and developing key communication and interpersonal skills with individuals from these communities.4 Even mentoring relationships with individuals from under-resourced communities has shown development in medical students outside of the classroom and allows them to envision themselves as physicians serving these communities.5
Understanding social determinants of health is the first step for medical students to shape their careers as physicians to help their community. Physicians must spend time individually with patients to understand the many factors that can affect their care such as reliable transportation, safe home environments, access to quality food, and like the focus of our project, access to secure housing. On a macro-level, physicians also need to advocate for their patients, working with community leaders to enact systemic policy changes that can mitigate the impact social determinants of health can have on equitable care.
There were many takeaways from our project that could be implemented in the future. The clearest conclusion was that we realized much of the healthcare community is unaware of the connection between social determinants and negative health impacts. Similar seminars should be in place to inform members both inside and outside of the healthcare community, and the first step in implementing this would be having future first-year medical students at the University of Cincinnati continue our project. Many aspects of the project can be improved, such as finding ways to increase seminar attendance and including a more robust quantitative survey to study the seminar's impact on participants. These improvements can be made by future cohorts of students.
I now have a clear understanding that my role as a physician is not simply to treat my patient's symptoms, but also to identify external obstacles they may face and search for solutions to combat social determinants of health. While the project only focused on homelessness as a social determinant of health, I hope to build relationships with other partners, understanding the gaps in healthcare in my community to address healthcare disparities. This experience has also shown me that while I must spend time with my patients to determine their medical needs, I must take the extra step in understanding the other factors that are affecting their quality of life. It is now clear to me that medical students should have to involve themselves in an immersive community experience focusing on the impact social determinants of health have on access to quality care. In addition, outside of the healthcare community, there are policies in place that directly affect the care we can provide to patients. The Affordable Housing Trust Fund illustrates the importance of physician awareness of political issues relevant to the healthcare needs of their community. What initially felt like a task in a first-year course became one of my most impactful experiences with takeaways that I plan to carry with me throughout my medical career.
None.
The Authors have no funding, financial relationships or conflicts of interest to disclose.
Investigation: SD. Writing – Original Draft: SD. Writing – Review & Editing: SD, and TL.
Cite as Dubbaka S, Lentz T. The Importance of Understanding Social Determinants of Health as Medical Students: My Experience with the Cincinnati Homeless Coalition. Int J Med Stud. 2024 Jan-Mar;12(1):109-111.
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Shivatej Dubbaka, 1 Second year medical student. University of Cincinnati College of Medicine, Cincinnati, United States of America.
Taylor Lentz, 1 Second year medical student. University of Cincinnati College of Medicine, Cincinnati, United States of America.
About the Author: Shivatej Dubbaka is currently a second-year medical student at the University of Cincinnati College of Medicine in Cincinnati OH in the United States, of a four-year program. He is also a recipient of the Summer Medical Student Respiratory Research Fellowship at Cincinnati Children's Hospital.
Correspondence: Shivatej Dubbaka. Address: 3230 Eden Ave, Cincinnati, OH 45267, USA. Email: dubbaksr@mail.uc.edu
Editor: Francisco J. Bonilla-Escobar; Student Editors: Theophilus Barasa, Abdelrahman Makram, & Marc Ronald Schneider; Copyeditor: L V Simhachalam Kutikuppala; Proofreader: Laeeqa Sanji; Process: Peer-reviewed
Copyright © 2024 Shivatej Dubbaka, Taylor Lentz
This work is licensed under a Creative Commons Attribution 4.0 International License.
International Journal of Medical Students, VOLUME 12, NUMBER 1, November 2023