How to Educate Otolaryngology Residents and Fellows on Social Determinants of Health

At the Practice Level

What does it mean to bake social determinants of health into routine practice for an otolaryngologist? The first step is raising awareness about and recognizing the significant impact of social determinants on a patient’s health and health outcomes. Like other specialties, otolaryngology is taking a closer look at health disparities within the specialty and how social determinants impact patient care and outcomes.

Uchechukwu Megwalu, MD, MPH, associate professor and chief of the division of comprehensive otolaryngology and otolaryngology clerkship director in the department of otolaryngology–head and neck surgery at Stanford University School of Medicine in California, and colleagues recently published an article on the growing evidence of healthcare disparities and social determinants of health in otolaryngology (Out of Committee: Outcomes Research and Evidence-Based Medicine. Bulletin. AAO–HNS. Published April 26, 2021). They discussed and cited evidence documenting disparities in a number of otolaryngologic areas, such as head and neck cancer, pediatric sleep apnea, and hearing loss, along with the powerful influences of nonmedical factors (race/ethnicity, socioeconomic status, geography, and insurance status), on health.

Separately, in an overview of the social determinants of health for otolaryngologists published in Laryngoscope Investigative Otolaryngology in 2017, researchers found that social determinants had a major effect on patient health and healthcare use; however, their study also pointed to the need for more data on how these factors can be addressed within otolaryngology (Laryngoscope Investig Otolaryngol. 2017;2:187-193).

Educating otolaryngologists on these issues is fundamental to addressing them in clinical care. Across clinical care, graduate medical education to include social determinants of health is under discussion. Some are calling it a “call to act” and offering specific key principles for implementing curricula focused on social determinants across all specialty groups (Acad Med. 2018;93:159-162). Some underscore the fact that the Accreditation Council for Graduate Medical Education (AGCME) has required health disparities education for residents for many years, and yet its inclusion in curricula is far from widespread (JAMA Netw Open. 2020;3(8):e2013097).

So, what’s being done in otolaryngology? General guidance is found in the preamble to the most recent ACGME program requirements for graduate medical education in otolaryngology–head and neck surgery, published in 2020: “Graduate medical education develops physicians who focus on excellence in delivery of safe, equitable, affordable, quality care; and the health of the populations they serve.”

Teaching clinicians to focus on the safe delivery of care with an eye to quality is foundational to healthcare delivery. Focusing on equitable and affordable care may be less tangible within the clinical context—and keeping an eye on the health of populations served is even more opaque. But the growing evidence on the impact of addressing social determinants of health and, in doing so, addressing health equity, is making these elements more tangible and less opaque for the clinician.