Social connection as a determinant of health: A mixed-methods assessment of resident physician knowledge, attitudes and behaviours

INTRODUCTION: Poor social connection is a risk factor for mortality comparable to smoking or obesity. Expert recommendations encourage clinicians to identify and address isolation, loneliness and absent social support; however, screening and documentation norms remain unstandardised in graduate medical education (GME) social determinants of health (SDOH) curricula. We assessed the knowledge, attitudes, and behaviours (KAB) of internal medicine resident physicians in a large, urban, academic medical centre regarding screening for and documenting social connection. METHODS: Between October 2022 and February 2023, a voluntary, anonymous mixed-methods survey was disseminated to assess resident physicians' KAB about social connection as a SDOH. Quantitative data were analysed descriptively. Qualitative responses underwent content analysis. An electronic medical record (EMR) chart review of resident notes corroborated survey data. RESULTS: Sixty-three residents of an eligible 153 responded to the survey (41% participation). Sixty-five per cent reported never receiving formal GME about social connection as a SDOH. Familiarity with validated screening tools was low. Although 51% of respondents reported often/always documenting patients' social support systems, few chart notes explicitly mentioned social contacts. Respondents agreed that physicians are responsible for assessing and documenting social connection and noted key challenges of time constraints, inadequate screening and documentation norms and EMR navigation difficulty. Targeted didactics, EMR improvements and interdisciplinary learning opportunities were identified as potential solutions. CONCLUSIONS: This study identified notable gaps in resident physician KAB to address social connection as a SDOH. Challenges could be addressed with standardised screening and documentation norms and skill development in patient communication and interdisciplinary teamwork.