Social determinants of health focused home and neighborhood visits: A mixed methods analysis of an internal medicine curriculum

Social determinants of health (SDH) contribute substantially to health outcomes and account for health disparities. Consequently, graduate medical education accreditation bodies have called for inclusion of social determinants of health (SDH) in medical training. Internal medicine (IM) physicians manage many health outcomes for which SDH have a significant impact, yet few residencies offer curricula on SDH.

Home visits are conducive to experiential teaching of SDH; they allow insight into patients’ living conditions, social supports, and challenges living with illness and competing priorities. Through a home visit and reflection, residents can partake in transformative learning, where first-hand experience leads to professional identity-formation that is more enduring. Coupling home visits with neighborhood asset-mapping contextualizes patient care within the neighborhood environment and extends learning beyond individual patients. No IM program has evaluated the use of a combined home visit and neighborhood assessment of continuity clinic patients as a tool to teach SDH. We conducted a mixed-methods study to understand the impact of this curriculum on residents and identify barriers to implementation.