Focusing on social determinants of health at Montefiore Medical Center

Each month, the AMA highlights institutions that are part of the AMA Accelerating Change in Medical Education Consortium to showcase their work with the consortium and innovations in medical education.

Catherine Skae, MD
Vice president and associate dean for Graduate Medical Education, designated institutional official
Montefiore Medical Center 
Number of years in the consortium: 2.5 years

Our group is working on Residency Training to Address Social Determinants of Health (SDH): Applying a Curricular Framework Across Four Primary Care Specialties—Family Medicine, Internal Medicine, Pediatrics, and Ob/Gyn & Women’s Health.

We have been developing competencies in prioritizing SDH knowledge and behavior learning goals; screening and referrals for social needs; expanding existing approaches in anti-racism, diversity, equity and inclusion; and promoting well-being in caregivers who predominantly serve the underserved. Our goals include training physicians (both learners and faculty) to be highly competent in addressing SDH as well as creating clinical learning environments that support the SDH curriculum.

Our team has been truly amazing: Drs. Anna Flattau, Victoria Gorski, Iman Hassan, Mary Duggan, Lauren Shapiro, Shwetha Iyer, Erin Goss, Megan McCabe, Sandra Braganza, Erika Banks, Kevin Fiori, Rachel Berman, as well as Paul Meissner, and Project Director Erka Amursi have continued the momentum of this work throughout the pandemic.    

We have completed literature reviews as well as learner and faculty needs assessments in 2020 and a social needs skills survey in 2021. Over 100 faculty members have participated in workshops on Undoing Racism with the People’s Institute for Survival and Beyond. Over 50 faculty members have participated in Purpose & Resilience Workshop Series with Rootwise Leadership.

Dr. Iman Hassan has spearheaded local and national Delphi surveys to gather expert opinions. We had over 200 house staff and faculty participate in an ACGME Requirement Day with a focus on SDH. We conducted a rigorous process to evaluate micro-grants with respect to their feasibility and relevance to the overarching goals of our AMA grant. Some of these projects include:

• Leveraging social media to promote training in SDH
• Investigating an intervention to increase hospital-wide SDH screening
• Screening for SDH in a sensitive, culturally competent manner
• A curriculum on intimate partner violence
• Evaluating a public health approach to SDH curriculum development
• Centering the community voice in the development of a longitudinal SDH curriculum
• An approach to engage medical learners on the effects of the opioid epidemic in the U.S.
• Empathy training and assessment in relationship to SDH knowledge, development and evaluation of health equity rounds, evaluating a faculty development series for medical educators in structural competency and anti-racism and narrative medicine: racism and health equity                

We conducted a well-being survey in May to assess the well-being of our learners.

Our work with the AMA and in the consortium facilitated the relationships that enabled these caring and generous colleagues to support and uplift us in the darkest of times. This work fostered the creativity and resilience to pivot as healthcare changed overnight. As the epicenter of disease burden at the beginning of the U.S. pandemic, we were called upon to share our experiences with other consortium members to help them prepare.

We relied on each other for strength and resolve. Our exposure to inspiring invited guests at AMA national meetings and those on AMA national calls provided meaningful experiences to bond, share and develop this incredible community of engagement.

There must be greater emphasis on health systems science, health equity, health care disparities, SDH and DEI efforts.

We must acknowledge burnout and provide multiple avenues to treat it because one size does not fit all. As physicians, we must prioritize self-care so we can help ourselves in order to help others. We must keep reminding ourselves about the why of what we do to strengthen our engagement and commitment to medicine.

We must celebrate the successes of health system transitions, new testing venues, telehealth, vaccines administered and project work continued, along with lives saved, compassionate care provided, the courage of all involved.