Expert Consensus Guidelines for Assessing Students on the Social Determinants of Health.

PHENOMENON: Assessment and evaluation guidelines inform programmatic changes necessary for educational effectiveness. Presently, no widely accepted guidelines exist for educators to assess learners and evaluate programs regarding social determinants of health (SDOH) during physician and physician assistant (PA) education. We sought to garner expert consensus about effective SDOH learner assessment and program evaluation, so as to make recommendations for best practices related to SDOH education. APPROACH: We used a Delphi approach to conduct our study (September 2019 to December 2020). To administer our Delphi survey, we followed a three-step process: 1) literature review, 2) focus groups and semi-structured interviews, 3) question development and refinement. The final survey contained 72 items that addressed SDOH content areas, assessment methods, assessors, assessment integration, and program evaluation. Survey participants included 14 SDOH experts at US medical schools and PA programs. The survey was circulated for three rounds seeking consensus, and when respondents reached consensus on a particular question, that question was removed from subsequent rounds. FINDINGS: The geographically diverse sample of experts reached consensus on many aspects of SDOH assessment and evaluation. The experts selected three important areas to assess learners' knowledge, skills, and attitudes about SDOH. They identified assessment methods that were "essential", "useful, but not essential", and "not necessary." The essential assessment methods are performance rating scales for knowledge and attitudes and skill-based assessments. They favored faculty and patients as assessors, as well as learner self-assessment, over assessments conducted by other health professionals. Questions about separation versus incorporation of SDOH assessment with other educational assessment did not yield consensus opinion. The experts reached consensus on priority outcome measures to evaluate a school's SDOH program which included student attitudes toward SDOH, Competence-Based Assessment Scales, and the percentage of graduates involved in health equity initiatives. INSIGHTS: Based on the Delphi survey results, we make five recommendations that medical and PA educators can apply now when designing learner assessments and evaluating SDOH programming. These recommendations include what should be assessed, using what methods, who should do the assessments, and how they should be incorporated into the curriculum. This expert consensus should guide future development of an assessment and evaluation toolkit to optimize SDOH education and clinical practice.Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2022.2045490 .

Assessment and Evaluation in Social Determinants of Health Education: a National Survey of US Medical Schools and Physician Assistant Programs.

BACKGROUND: Social determinants of health (SDOH) curricular content in medical schools and physician assistant programs are increasing. However, there is little understanding of current practice in SDOH learner assessment and program evaluation, or what the best practices are. OBJECTIVE: Our study aim was to describe the current landscape of assessment and evaluation at US medical schools and physician assistant programs as a first step in developing best practices in SDOH education. DESIGN: We conducted a national survey of SDOH educators from July to December 2020. The 55-item online survey covered learner assessment methods, program evaluation, faculty training, and barriers to effective assessment and evaluation. Results were analyzed using descriptive statistics. PARTICIPANTS: One hundred six SDOH educators representing 26% of medical schools and 23% of PA programs in the USA completed the survey. KEY RESULTS: Most programs reported using a variety of SDOH learner assessment methods. Faculty and self were the most common assessors of learners' SDOH knowledge, attitudes, and skills. Common barriers to effective learner assessment were lack of agreement on "SDOH competency" and lack of faculty training in assessment. Programs reported using evaluation results to refine curricular content, identify the need for new content, and improve assessment strategies. CONCLUSIONS: We identified a heterogeneity of SDOH assessment and evaluation practices among programs, as well as gaps and barriers in their educational practices. Specific guidance from accrediting bodies and professional organizations and agreement on SDOH competency as well as providing faculty with time, resources, and training will improve assessment and evaluation practice and ensure SDOH education is effective for students, patients, and communities.

A Strategy for Teaching Health Literacy to Physician Assistant Students.

This brief report presents a model that incorporates an analogous "see-one," "do-one," "teach-one" pedagogical strategy and experiential learning for mastery of health literacy principles by first-year Master of Science in Physician Assistant Studies students. Students completed a series of health literacy activities including classroom-based lecture (see-one), hands-on application of health literacy activities (do-one), and application and peer-instruction of health literacy best practices with other health science students (teach-one) as part of a two-semester hands-on learning experience. A health literacy knowledge examination, qualitative student feedback, and faculty review of content application were used to assess for effectiveness. Students demonstrated a significant and sustained positive change in knowledge examination scores complemented by positive faculty poster review. Physician Assistant student health literacy knowledge is increased and sustained after application of see-one, do-one, teach-one strategy with students demonstrating health literacy considerations in real-client application during experiential learning. Education programs seeking to meet the call for health professionals prepared to address gaps in health literacy should consider a see-one, do-one, teach-one and experiential learning approach over multiple semesters. [HLRP: Health Literacy Research and Practice. 2021;5(1):e70-e77.].

Students' Knowledge and Self-Perceptions Regarding Integrative Medicine and Health Following Training in First-Year Graduate PA, PT, and OT Programs.

Integrative medicine and health (IMH) content and pedagogy for health professional education best practices are not established. Physician assistant (PA), physical therapy (PT), and occupational therapy (OT) students' knowledge and self-perception of integrative health, lifestyle behavior change, and professional well-being were assessed pre- and post- participation in IMH online modules. Students demonstrated significant increases in knowledge and self-perception scores from pre- to post-test. Pre- and post-test knowledge score means varied by discipline. Pre-test self-perception score means did not vary across disciplines, while the post-test self-perception score mean was significantly higher for PA students compared to other disciplines. Online integration of IMH content does not require significant curricular revisions and is a promising pedagogy for increasing PA, PT, and OT students' understanding of the IMH approach.

Very high-dose ergocalciferol is effective for correcting vitamin D deficiency in children and young adults with cystic fibrosis.

Approximately 10-80% of patients with Cystic Fibrosis (CF) have vitamin D deficiency. Obtaining therapeutic vitamin D levels has been a challenge for CF care providers using current recommended high-dose oral ergocalciferol (400,000 IU over 2 months). The objective of this study was to evaluate the safety and efficacy of a 2-week, very high dose ergocalciferol (700,000 IU over 14 days) repletion strategy in children and young adults with CF. As part of a quality improvement initiative, a prospective cohort study was performed from January through May 2007. Phase I included identifying individuals with CF who were subtherapeutic in 25-OH D. In phase II, 50,000 IU of ergocalciferol was prescribed for a 14 day term and administered daily. During phase III, a post treatment 25-OH D level was obtained to determine improvement. Baseline demographics and clinical characteristics were obtained at study entry. Stratification of the post 25-OHD levels was defined. Eighteen individuals with CF participated in the study. The mean age was 17+/-5 years (range 6-25 years). One hundred percent were pancreatic insufficient and required pancreatic enzyme replacement. All 18 had 25-OHD levels less than 30 ng/mL pre-treatment. Seventeen of the 18 (94%) participants became therapeutic in the 2-week interval. No patients had values considered high abnormal (100-150 ng/mL) or toxic (>150 ng/mL). Mean change was noted at an increase of 37.3+/-22 ng/mL in the 2-week period (p<0.001). Pre and peripubertal individuals had a significantly greater increase in 25-OH D levels. The results of this study demonstrate that very high dosing of vitamin D using oral ergocalciferol over a 14 day period is an effective strategy in achieving therapeutic levels of 25-OH vitamin D in children and young adults with CF. We believe this regimen deserves further study.