Interprofessional Competency Development to Address Social Determinants of Health (SDOH) Using Virtual Reality (VR): A Training and Research Project

Background and Purpose: An estimated 80% of health outcomes are contributed to a patient's conditions outside the clinical offices, related to behaviors, and socioeconomic and environmental factors known as the SDOHs. However, SDOH are generally overlooked and under-acknowledged in traditional healthcare settings. Healthcare providers face many hurdles, including limited SDOH assessment and intervention skills, the lack of organizational systems and support for addressing SDOHs, and less than optimal inclusion of social workers on multidisciplinary clinical care teams (Glenn et al., 2024). Innovative training that provides opportunities for healthcare and social work (SW) students to learn how to collaboratively assess and address SDOHs is needed to overcome some of these barriers. The Boston University (BU) Interprofessional SDOH Learning Initiative (SDOHLI) is a collaboration between the BU Medical, Nutrition and SW disciplines. Students collaborate in multidisciplinary teams to practice assessing patients’ SDOH and role-play patient-provider interactions utilizing VR simulation.

Methods: From May 2022 to May 2023, 100 nutrition, SW and medicine students convened virtually for a total of 48 simulations, facilitated by faculty from the three disciplines. Session transcripts and faculty field observations were analyzed thematically to evaluate process and learning outcomes. Students completed pre- and post-simulation surveys which collected Likert scale responses on the Collaborative Competencies Attainment Survey (ICCAS) and confidence levels in addressing SDOH. A paired t-test was used. Among the completed pre (n=133) and post (n=55) surveys, there were 51 matching IDs. Open-ended surveys were analyzed thematically.

Results: The quantitative analysis showed that students had increased confidence in their ability to discuss, identify and share resources related to SDOH (p <0.001). Observations showed that SW students took a leadership role challenging other students and modeling a patient-centric approach to assessing and delivering care by drawing on their preexisting SDOH knowledge. On open-ended surveys, students reported appreciation for learning about the role of social workers in the field, questioned existing hierarchies and siloed work in medical settings, and acknowledged the importance of working collaboratively in a multidisciplinary setting to address SDOH. A student commented: “I felt like the social worker was much more qualified to take the lead in the simulation where we consulted the patient together.”

Conclusions and Implications: The SDOHLI demonstrates both the value of multidisciplinary work to address SDOH, and the importance of leveraging the SW perspective and leadership in healthcare delivery settings. To support patients holistically and improve health outcomes, medical education must prioritize multidisciplinary care and collaborate with social workers who bring their patient-centered, person-in-environment, relational healthcare perspective. By integrating innovative interprofessional education and learning into medical education and training curricula, providers can be better prepared to adequately address the complex medical and social needs of their patients. VR simulations followed by debriefing sessions with faculty are a promising educational option to bring students from different disciplines together.