Developing the Community Engaged Physician: Medical Students Reflect on a Household Visit Curriculum.

Introduction:  To educate students about social determinants of health, our medical school assigns interprofessional student teams to work longitudinally with underserved households to identify and address their health and social needs. To cultivate reflective practice--an essential component to training competent professionals through service-learning programs--students are asked to recognize their emotional responses to patient encounters. This project used reflective essays to identify the emotional responses of medical students to the start of their household visit experience and to assess their observations in relation to social determinants of health.

Methods:  Thematic analysis was used to examine patterns in reflective essays provided by 99 medical students. Two independent reviewers read the essays and created initial codes, which were developed into a common codebook by consensus. Codes were categorized into themes, including observations of the social determinants and emotional reactions to household visits.

Results: Through the provision of household-centered care, medical students recognize the roles that social determinants play in the health of patients, households, and communities. Furthermore, they are able to identify household and community level interventions to address these identified needs. A variety of emotional responses to household visits were identified, ranging from frustration and sadness to empathy and humility.  Conclusions: Medical students undergo an emotional evolution even at the start of their household visit experience; highlighting that early patient care responsibilities play an important role in their development from pre-professional students to doctors-in-training. Additionally, student observations of the social determinants suggest that household visits can provide an opportunity for the application of knowledge about identifying and addressing these barriers to care.