Social Issues in Medicine, a class offered at the University’s Medical School, is unique — both in its mission of introducing medical students to social issues that affect health and in its structure of participating in a wide variety of community-service projects.
The class, a required course for first-year medical students, was founded 14 years ago by Dr. Mohan Nadkarni, a professor of medicine at the University’s Medical School. The course focuses on teaching students to approach healthcare in a more holistic way, according to Nadkarni’s phone interview with The Cavalier Daily.
“Medicine has paid, particularly at that time, but even now, pays less attention to those [social] aspects of care, and we wanted care to be more holistic, so we wanted to train brand new [medical] students ... about the social determinants of health,” Nadkarni said.
According to China Scherz, assistant professor and director of graduate studies in the department of Anthropology, these social determinants are crucial to consider in order to fully address patients’ health.
“Rather than thinking about the body in isolation from society or people's daily lives, [it’s] trying to … place the body as it really is within that broader context,” Scherz said.
Scherz further explained the idea of social aspects affecting health by illustrating an example with diabetes.
“If you're going to think about diabetes, you have to think not only about the pancreas — you have to think about what's the food system that that person is embedded in,” Scherz said. “What kinds of foods do they have access to, what is their economic situation[s], and how is that going to impact where they can go grocery shopping and how much time they have to cook.”
Dr. Rebecca Dillingham, director for the Center for Global Health, also highlighted access to proper healthcare and provider biases as major socio-cultural issues facing patient’s care in an email statement to the Cavalier Daily.
“It is essential that structural barriers to health care access be removed and that attention is focused on how to train all health care providers to become aware of how implicit and explicit biases can impact their care as well as their responsibility to reduce or eliminate this impact,” Dillingham wrote.
Dillingham also said that fostering a healthy lifestyle and reducing providers’ implicit and explicit biases are issues specifically facing the Charlottesville community. She noted that the Thomas Jefferson Health District has helped identify these areas of priority and combatted these issues by promoting healthy eating, active lifestyles and addressing both mental health and substance abuse.
In addition to helping students understand these social determinants of health within the community, Nadkarni said, the purpose of SIM is to also instill the importance of community service. Hence, along with traditional large lectures on various social determinants of health, the class is structured around service projects with several agencies in Charlottesville.
Students have done a variety of tasks to help community health. Some include preparing 25,000 pounds of healthy snacks to distribute to students at nine area schools, working at the Children’s Fitness Clinic to teach about obesity and developing a Spanish math workbook for students to help them perform better in school.
The Charlottesville Free Clinic, co-founded by Nadkarni and Dr. R. Paul DeMarco, is another agency that students have worked with through the class.
The clinic puts primary care under one roof for the low income, working population of Charlottesville, according to CFC Executive Director Colleen Keller’s phone interview with The Cavalier Daily. She continued by saying a complex combination of race, income and housing situations can result in people using the emergency room as their primary care.
Additionally, SIM students working at the CFC have helped patients fill out a simple questionnaire for anxiety and depression called the PHQ 9, Keller said.
The work the students do has largely helped the clinic and its patients since mental health screens are often lost under the radar at clinic visits.
"A PHQ 9 score is a vital sign, just like everything else,” Keller said. “And I think having them [students] work on it was instrumental in just having it flow through the clinic every night."
Nadkarni also said that over the years, both mental health and substance abuse have become larger areas of interest for the SIM class as they are relevant issues to the Charlottesville community.
University medical students reported not only understanding the importance of treating the patient holistically, but also having experienced a level of personal growth through the class.
Jeffrey White, a second-year medical student in the Generalist Scholars Program, volunteered at the Albemarle County Regional Jail where students taught weekly health literacy classes on topics such as sexual health, mental health, diabetes, drug and alcohol abuse and nutrition.
White commented in a phone interview that his experience in SIM helped him relate to people who may seem quite different.
“It really just showed us that we all have... the same kind of drives and the same kinds of needs,” White said.
Another second-year medical student, Anna Hakkenberg, partnered with Hospice of the Piedmont for her SIM assignment. She volunteered with a bereavement camp that organized music therapy and art therapy for children to better address their grief after a family member had died.
“It definitely helped me gain a deeper understanding of just how profound that impact can be … If you don’t know these various social, economic and different aspects of their life, you can’t treat them effectively,” Hakkenberg said.
White said that in order to provide all first-year students with a smooth experience, it would be helpful if students create a framework that future first-year students can use. While newly-formed SIM partnerships have to develop project goals on their own, well-established ones benefit students by giving them a precedent to follow.
“I think the idea of a continuity between years of ... the previous class setting up a system for the next class to really hit the ground running really served us and could [help] other groups very well,” White said.
Students in SIM are establishing bonds with the people they serve at the agencies. “I'm most proud of the amount of community service learning that has gone on — over 60,000 hours over the course of the course,” Nadkarni said.
In terms of the future of the class, Nadkarni said that he hopes the number of community service projects, currently at 27, can be expanded and that community health outcomes can be further improved. He also expressed an interest in increasing community service participation throughout students’ four years at medical school.
Keller echoed Nadkarni’s sentiment, saying, “SIM was a good early pilot and we're hoping there's a permanent rotation that brings people in the community."
“In the time of health records, SIM is really important,” Keller said. “You're seeing every one of these students is going to have less time with the patient, more time on the computer; it accentuates how important it is for them to be in environments where you have a relationship [with patients],” she added.
Nadkarni said he is encouraged by the progress. “I'm just happy that we as the University are at least taking steps to address social determinants of health as an important part of health outcomes,” he said.
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