What’s your SPARK?

Integrative Critical Reflection of Social Determinants of Health (SDoH)

Innovations in Medical Education Conference | February 15-16, 2024

Angelico Razon, MD MPH MSHP FAAP; Ashwini Lakshmanan MD MS MPH FAAP; Anne T. Vo, PhD CE; Gery W. Ryan, MA, PhD; Daisy Paez, BA; Loel S. Solomon, PhD MPP

Kaiser Permanente Bernard J. Tyson School of Medicine (KPSOM)

Health Systems Science (HSS) is a part of our medical school’s required curriculum. This project focuses on the Community & Population Health (CPH) domain. Read more about HSS domains below.

This is a selection of classroom-based sessions that coveres Community and Population Health. Each session is a large group discussion (similar to a “morning report”) on a contemporary CPH Challenge by applying specific Analytical Frameworks. A Guiding Reflection Question prompts students to apply this analysis to their own interests, projects, and learning experiences. 

Health Systems Science at KPSOM

Define Community and Population Health

Measure & Improve CPH

Social Isolation in the Elderly

What community or population are you interested in exploring?

How is that community or population defined?

How would this community or population define or measure health?

Racial Disparities in Maternal and Infant Mortality

Community Needs, Assets, & Opportunities

What is a source of information that provides opportunities to understand or improve health for this community or population?

Engaging Interested Parties

Stakeholder Engagement  and Systems Ethics

School Closures and COVID

Name 2 specific stakeholders connected to this community or population that you would like to learn more from.

What potential tradeoffs exist between stakeholder perspectives?

Social Drivers of Health

Structural Humility

Lead Water Contamination

Describe relevant behavioral, environmental, and structural drivers of health in this community or population.

Select one component of structural humility. What strategy could you use to further explore this component during your training?

Systems Thinking and Health Policy Analysis

Outbreaks of Vaccine Preventable Illness

What CPH challenge do you care about? How does this challenge represent the four characteristics of a systems problem? What stocks, flows, and feedback  loops are relevant?

Emergency Declaration on Homelessness

Structural Analysis

Selecting and Implementing CPH-Level Interventions

What social mediators (policies, practices, and social norms) and structural determinants of health (political, economic, and institutions) are relate to your CPH challenge?

Select a potential intervention for your CPH challenge. Evaluate this intervention along the six selection criteria discussed in class.

Gun Violence

Role of Healthcare Organizations

Role of Physicians

Considering anchor strategies, what opportunities do healthcare organizationshave in addressing this CPH challenge.

Describe your role in relation to this CPH challenge.

The “SPARK” Assignment

Structural Perspectives, Awareness, & Reflection at KPSOM

At different timepoints through the series, students compile these reflections into a comprehensive essay (the “SPARK assignment”). Faculty provide feedback based on the student’s framing of complex problems and addressing uncertainty, which are core concepts of our HSS curriculum.

Project Next Steps

Guided by the Reflective Judgment Model, we propose a retrospective, iterative qualitative analysis of students' SPARK assignments. Because faculty provide formative feedback over the course of two years, we aim to track students’ progress through deeper levels of reflection. Our evaluation will identify what inspires student interest in community and population health challenges, including clinical and personal experiences. We will determine which curricular activities prompt student reflection, such as classroom discussions or community immersion.

Examples of Levels in Reflective Judgment Model

  • Pre-Reflective

    Sees problems as having definite answers. Struggles with uncertainty. Defaults to rigid beliefs.

  • Quasi-Reflective I

    Differentiates between structured and complex problems. Struggles with deconstructing complex problems. Sees all solutions as equal.

  • Quasi-Reflective II

    Recognizes different perspectives but does not integrate all views. Uses logic but hesitates to commit.

  • Reflective I

    Understands the need for subjective evaluation and applies principles to include various perspectives. Weighs viability of solutions.

  • Reflective II

    Updates knowledge when new views are explored. Constructs complex frameworks to address problems. Presents persuasive arguments with critical evaluation.

More About HSS At KPSOM

Health systems science is the principles, methods, and practice of improving quality, outcomes, and costs of healthcare delivery for patients and population with systems of medical care. At KPSOM, our HSS curriculum consists of several domains and several exerperiential learning activities. These domain include Quality & Safety, Healthcare & Social Systems, Inquiry, Community and Population Health, which are further described below.

  • Inquiry

    Is my decision evidence-informed? How do I best answer a clinical question?​

  • Quality & Safety

    How can we change clinical workflows to improve efficiency?​

  • Healthcare & Social Systems

    How can I improve my patient’s access to care or reduce their cost of care?​

  • Community & Population Health

    How are social determinants affecting my patient’s and similar patients’ health, and how should that alter my practice?​

  • Interprofessional Collaboration

    Multi-institutional collaboration employing didactic, simulation, and small group learning.

  • Service-Learning

    Longitudinal practicum with community partners at Federally Qualified Health Centers (community-defined health inequity addressed through an improvement effort)​

  • Scholarly Project

    Longitudinal mentored scholarly project (student-specific topic of interest addressed through the process of scientific inquiry and discovery)​

  • Quality Improvement Project

    Longitudinal QI project within FM/IM clerkships (systems-based care gap addressed through a team-based, student-led improvement effort)

  • Selectives

    Advanced application of HSS concepts in classroom, clinical, administrative, or community settings through courses or practica​