How to teach Socioeconomic Status Classification to 1st year MBBS (Bachelor of Medicine, Bachelor of Surgery) students under the CBME (Competency-Based Medical Education) framework?

Teaching Socioeconomic Status Classification to 1st Year MBBS Students Under CBME

For teaching SES classification to first-year MBBS students in the CBME framework, adopt a competency-based approach that integrates theoretical understanding of SES components (education, occupation, income) with practical assessment tools and early clinical exposure through structured community engagement programs like the Family Adoption Program.

Core Conceptual Framework

Define SES Using Multi-Dimensional Components

• Teach SES as comprising three interconnected factors: education, occupation, and income that together determine an individual's position in stratified society 1.
• Emphasize that socioeconomic position (SEP) and socioeconomic status (SES) are often used interchangeably but represent the same fundamental concept of economic and social positioning relative to others 1.
• Highlight that lower SES consistently associates with worse health outcomes across multiple disease conditions, making this classification clinically relevant 1.

Address the Clinical Relevance Early

• Connect SES classification directly to health outcomes: explain how social and life disadvantages lead to poor health, including lack of access to food, shelter, and healthcare resources 1.
• Demonstrate that social determinants of health (SDOH) are responsible for major health inequalities worldwide and are often unrecognized in clinical encounters 1.
• Use the Healthy People 2030 framework's five domains: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context 1.

Practical Teaching Strategies for CBME

Integrate Assessment Tools into Learning

• Introduce standardized screening tools like the Accountable Health Communities' 10-item social needs screening tool, which assesses housing instability, food insecurity, transportation needs, utility needs, and interpersonal safety 1.
• Teach students that there are currently no universal standards for SDOH screening, so they must select tools appropriate to their practice setting 1.
• Emphasize practical application: results from screening tools should inform treatment plans and referrals to community services 1.

Leverage the Family Adoption Program (FAP)

• Utilize FAP as the primary experiential learning platform: approximately 90% of students perceive FAP as beneficial for personal and professional growth 2.
• Through FAP, students witness firsthand the living situations of patients and learn how various health factors impact them in real-world settings 2.
• Ensure faculty engagement as the main facilitator, as this is the primary factor encouraging student participation 2.

Structure Horizontal and Vertical Integration

• Implement horizontal integration across subjects in the same academic year, as this is more appreciated by students than vertical integration 3.
• Connect SES classification teaching with early clinical exposure sessions and attitude ethics communication modules, which three-fourths of students find necessary 3.
• Integrate with community medicine rotations where students can apply SES assessment in real community settings 2.

Address Critical Educational Challenges

Combat Implicit Bias Early

• Explicitly teach that first- and second-year medical students already demonstrate negative perceptions of low SES patients on multiple dimensions, including compliance, social support, and prognosis 4.
• Students perceive low SES patients as less compliant with medications, less likely to return for follow-up, and having poorer overall health 4.
• Second-year students are less inclined to want low SES patients in their practice, highlighting the urgency of early intervention 4.

Provide Cultural Competency Training

• Teach that cultural factors impact how patients participate in their own care and that perceptions of disease are shaped by cultural factors and social positions 1.
• Emphasize that socio-demographic data should be collected consistently and interpreted within specific cultural and demographic contexts 1.
• Address that 70% of physicians have implicit preference for whites over blacks, which affects medical decision-making and communication 1.

Implement Competency-Based Assessment

Use Continuous and Criterion-Based Evaluation

• CBME requires assessment processes that are more continuous and frequent, criterion-based, and developmental 5.
• Implement work-based assessments where possible, using both quantitative and qualitative measures 5.
• Utilize group processes in making judgments about trainee progress rather than single evaluator assessments 5.

Practical Application Exercises

• Have students screen for SDOH using a nonbiased approach during clinical encounters 1.
• Teach students to provide patient education about SDOH and clinical care resources to address them, including social service resources 1.
• Practice open communication with patients about needs, cultural differences, and social network dynamics that affect family decisions 1.

Common Pitfalls to Avoid

Don't Oversimplify Population-Level Data

• Racial, ethnic, and ancestral groups are not monoliths but aggregates of diverse individuals with intersecting identities 1.
• Within SES categories, individual differences in class, gender identity, educational attainment, occupation, and residential neighborhood significantly modify risk 1.
• Avoid applying population-level data rigidly to individual patients without considering these intersecting factors 1.

Address Student Concerns About Implementation

• Students perceive maintaining logbooks as time-consuming and cumbersome 3.
• Consider curtailing duration of foundation courses and providing better synchronized vertical integration based on student feedback 3.
• Ensure exemplary implementation of adult learning techniques to maintain student engagement 3.

Recognize SES Diversity Among Students

• 52% of medical students come from high SES backgrounds and only 18% from low SES 6.
• Low SES students show greater willingness to have low SES patients in their practice compared to high SES students 4.
• Use this diversity constructively by facilitating peer learning and perspective-sharing 4, 6.

Specific Teaching Content

Classification Systems to Cover

• Parental education and occupation (EO indicator): classifies individuals into five ordered groups based on four aggregated categories of parental education and two categories of occupation 6.
• Income-based classifications: teach the poverty threshold definitions (e.g., in the US, individual income less than $34 per day) 1.
• Multi-domain frameworks: economic stability, education, healthcare access, neighborhood environment, and social context 1.

Link to Clinical Scenarios

• Food insecurity affects one-fifth of adults with diabetes and increases risk for uncontrolled hyperglycemia and severe hypoglycemia 1.
• Two-thirds of patients with chronic illness who don't take medications due to cost never share this with their physician 1.
• One-third of patients hospitalized with heart failure are unemployed 12 months later, demonstrating the bidirectional relationship between health and SES 1.