We present a 9-month pilot course on the social determinants of health for medical and other health professional students, which is based at Puentes de Salud, Philadelphia, PA, USA, a community health center serving a Latino immigrant population. Despite increasing interest in teaching the social determinants of health in undergraduate medical education, few models exist.
Given the large influence of social conditions on health, physicians may be more effective if they are trained to identify and address social factors that impact health. The pedagogy, in use for four years, is being adopted by another department, indicating the sustainability and success of the course. Barriers to implementing this approach were also highlighted. They recognised the importance of holistic, patient-centered care based on a biopsychosocial approach and the importance of the PHC principles. Students described the teaching pedagogy as interesting and informative. The methodology uses real patient encounters linked to an interactive seminar and a portfolio of case studies. This paper describes an educational pedagogy which weaves these principles into clinical practice in an undergraduate medical clerkship.
In 1994 the University of Cape Town (UCT), South Africa, adopted a PHC-based approach to health sciences education to equip its graduates with the necessary knowledge, skills and attributes required to meet the challenges of providing health care in a country with vast socio-political inequalities. A teaching pedagogy blending the biopsychosocial approach and the principles of primary health care (PHC), as expressed in the Alma-Ata Declaration of 1978, is lacking in the literature. The importance of behavioural and social determinants in health was recognised long ago, yet we still grapple with the challenges of developing appropriate teaching pedagogies to bring these principles into routine clinical practice. In the future, further documentation of the use of the PFC matrix particularly in primary care in the light of universal health care and how it impacts on outcomes and how it connects patients and families at the correct tiers of the health system. This results not only in optimal health for the patient but impacts to create a more responsive health system. Through the use of this matrix, the family physician is able to manage the patient in a holistic manner by recognizing patient needs, creating an enabling family support environment and helping the patient and family navigate various community resources. Lastly, the community-oriented component enables the family physician to use social determinants of health and health systems as a lens to understand how larger systems support or hinder the provision of care. The family-focused component of the matrix utilizes family assessment to generate assumptions on how the family dynamics affect or facilitate the prescribed management of the patient’s disease. The patient-centered care utilizes understanding of the interplay of biomedical psychosocial factors disease in order to implement management that is tailor-fitted to the needs and values of the patient. This article discusses the development of a learning tool called the PFC matrix which is a patient-centered, family-focused and community-oriented approach to care for individual patients and their families. Little is done in showing how the biopsychosocial approach can be used in the day to day family practice. Teaching this approach in family medicine is usually highlighted in family case presentations and counseling sessions. Biopsychosocial (BPS) approach to care is essential in family practice.