Discovering Why Neurology Residents Don’t Identify Social Determinants of Health Using Design Thinking (and How to Fix it!)

Purpose: Teaching residents to identify and act on social determinants of health (SDH) issues in our resident’s outpatient clinic is done through lecture format. A 2-pronged needs assessment (quantitative survey and subsequent qualitative group interview process) determined that our residents did not apply their SDH knowledge to patient care in the neurology clinic. This classroom-to-clinical practice gap was explored by actively engaging residents in the development and application of tools to obtain SDH data and how to solve SDH problems. This process provides residents with direct education on system-based practice (SBP) as part of an American Medical Association-funded grant to develop SBP education guidelines. Approach: All Geisinger neurology residents and 2 core faculty members used the design thinking approach to identify and explore the attitudes and understanding of SDH. This approach included group discussions plus residents shadowing and interviewing multiple stakeholders (patients, department support staff, and social workers). Data collected were used to (1) understand the barriers to residents obtaining SDH data, (2) define the workflow and environment available to collect SDH information from patients, and (3) develop tools to obtain appropriate SDH data and use them for patient care. Outcomes: The most commonly identified barriers to obtaining SDH data were a lack of practical patient interviewing skill (including perceived embarrassment to the resident and the patient), limited staff physician’s education in SDH, and the sense that addressing SDH problems was beyond the resident’s skill set. Residents took these findings to create and solve a single problem statement, “How might we teach each other to recognize SDH so that we can next determine the best ways to address SDH problems in our patients.” Through exploration of the patient journey, residents prototyped 3 mechanisms for obtaining SDH from patients before their visit and generated readily available solutions for their most common SDH. Significance: Using a design thinking method created multiple opportunities for real-life education including SDH issues and SBP education via interacting with a multitude of stakeholders and developing quality improvement initiatives, which were based on qualitative and quantitative data. Creating prototypes and formally testing them, creating outcome metrics, and developing subsequent improvements will provide longitudinal education and pave the way for future resident-driven education

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