Linking the social determinants of health and disease process using concept mapping in pre-clerkship problem-based learning courses: a pilot study

The Social Determinants of Health significantly impact patient care, and understanding their role in the disease process and patient management is essential to high-quality healthcare. Several barriers exist to integrating social determinants of health into medical curricula, including the lack of consensus on evidence-based teaching methods. In this context, our study investigated the impact of integrating social determinants of health into pre-clerkship problem-based learning courses using concept mapping on the clinical problem-solving process. Fourteen pre-clerkship medical students voluntarily participated and were randomly assigned to control and experimental groups. The experimental group education intervention included two problem-based cases with social determinants of health-informed probes to promote linking those determinants to the disease process and develop a treatment plan using concept mapping. The control group participated in the same cases without the education intervention. Students in both groups completed post-session assignments that included two new cases, individual concept maps, and recorded reflections. Concept maps were scored using a scoring rubric. The scores of both groups were compared using the Mann-Whitney U test. Recorded reflections and concept maps were analyzed using reflexive thematic analysis coding method. Quantitative data analysis showed that the experimental group received significantly higher scores than the control group. Qualitative data analysis highlighted substantial differences in clinical problem-solving approaches. The control group's clinical reasoning approach focused mainly on the clinical aspects of the case. The experimental group followed a social determinants of health-informed clinical reasoning approach to patient-centered treatment plans with balanced therapeutic/nontherapeutic elements.