Teaching the Social Determinants of Health Through Medical Legal Partnerships: A Systematic Review

Background: Medical education is increasingly focused on the social determinants of health (SDoH), but questions remain regarding how best to ensure that trainees become empowered to take action on the SDoH in their future practice. The authors conducted a systematic review to better define the impact that educational programs centered on medical legal partnerships (MLP) have on trainees’ knowledge, attitudes and future practice. Methods: The authors sourced data from PubMed, Web of Science, Index to Legal Periodicals, LegalTrac, Google Scholar, Academic Search Complete, Business Source Complete, SocINDEX, SSRN, and Proquest Social Sciences. Selected studies included those centered on Medical Legal Partnerships in graduate medical education and that measured outcomes of the participating trainees. Two abstractors independently extracted information about the study population, setting, design, intervention and outcomes. The literature search was conducted in 2019. Results: : Six out of 483 studies met the inclusion criteria. One study highlighted three different MLPs, thus eight total MLP programs were included. Trainees included residents from pediatrics, family medicine and internal medicine. Interventions ranged from didactic sessions, to advocacy projects, to hands-on community-based learning, to poverty simulation trainings. Benefits to trainees were wide in scope but all programs showed improvements in participants’ understanding, comfort, confidence, and/or abilities in identifying and intervening on SDoH in their patients. Conclusion: As undergraduate and graduate medical education is increasingly considering how to effectively teach trainees to understand and address SDoH, the findings in this systemic review suggest that inclusion of Medical-Legal Partnerships into training programs is an effective approach.