Gap Between Understanding the Social Determinants of Health and Action Among Attending and Resident Surgeons

INTRODUCTION: Social determinants of health (SDoH) impact clinical outcomes, yet surgeons may fail to translate understanding of SDoH into practice. Our aim was to explore provider understanding, perceived importance, and practices regarding SDoH at our institution. METHODS: Attending and resident physicians at a single academic medical center completed surveys regarding SDoH. Attending and resident responses were compared using chi-square and Wilcoxon rank sum tests. We conducted semi-structured interviews to further explore understanding and perceived importance. Three researchers used inductive and deductive logic guided by the WHO SDoH conceptual framework to code transcripts and identify themes. RESULTS: Survey response rate was 46.0% (n = 69; 44 residents [63.8%]; 25 attendings [36.2%]). Most respondents reported good understanding of SDoH (58.6%; n = 41), and 94.3% (n = 66) perceived understanding to be important. However, fewer respondents reported screening (37.1%; n = 26), documenting (14.3%; n = 10), or referring patients (18.6%; n = 13). There was no significant difference between resident and attending response; however, 95.5% of residents (n = 42) reported previous SDoH training compared with 56.0% of attendings (n = 14; p < 0.001). We conducted 10 interviews (4 attendings, 6 residents). Resident understanding often included impact of both socioeconomic and specific determinants, while attendings emphasized specific determinants. Neither group mentioned political context. CONCLUSION: Self-reported understanding and importance of SDoH were high; however, interviews revealed gaps in understanding, which may contribute to reduced practices that address patient needs. Differences between residents and attendings may be due to level of previous training and will inform future targeted educational and quality improvement interventions.