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A Role-Playing Activity for Medical Students Demonstrates Economic Factors Affecting Health in Underprivileged Communities

Authors Loyola AB, Palileo-Villanueva LM

Received 25 April 2020

Accepted for publication 3 August 2020

Published 9 September 2020 Volume 2020:11 Pages 637—644


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Md Anwarul Azim Majumder

Aldrin B Loyola, Lia M Palileo-Villanueva

Department of Medicine, College of Medicine, University of the Philippines – Manila, Manila, Philippines

Correspondence: Aldrin B Loyola
Department of Medicine, University of the Philippines – Manila, 547 Pedro Gil Street, Ermita, Manila 1000, Philippines
Tel +632-85548400 ext. 2057
Fax +632-85260371

Background: Innovative teaching-learning strategies are necessary to promote community orientation and foster awareness of the social determinants of health among millennial learners in the health professions.
Methods: The authors designed a role-playing simulation activity that aims to highlight the multidimensional nature of health and develop in students an appreciation of the day-to-day experiences of underserved populations. The current investigation aimed to evaluate the utility of the role-playing activity and guided reflection in terms of the students’ appreciation of economic factors that affect health and health-seeking behavior of patients and their recognition of the role of healthcare professionals with respect to issues related to poverty and health. Thematic analyses of the insights and observations of the students immediately after the activity and the anonymized reflection papers were done to identify recurring ideas that made an impression on them.
Results: The students were able to identify that in a setting with limited employment opportunities and low-income potential, the residents prioritized food and shelter over everything else. They also chose cheaper products over healthier options. Practically everyone forewent out-of-pocket healthcare expenditure in order to minimize its disruptive consequences. In these settings, the students highlighted the role of society and government in the provision of services and in community development. The students also emphasized the necessity for competition among a number of providers of goods and services to reduce prices. When asked if healthcare professionals are contributing to the widening gap between rich and poor, 70% agreed, 9% disagreed, 14% did not give a direct answer, and 7% said that healthcare professionals contributed in some ways and alleviated in other ways. The most commonly cited behavior that contribute to this disparity are the decision to seek highly specialized training, the congregation of practitioners in highly urbanized centers, and inattention to the economic difficulties of most patients. Those who disagreed with the statement cited systemic problems as the driving force that widens the disparity. In particular, these students cited the commodification of healthcare and related services, inappropriate policies, and insufficient funding specifically for services and health human resources.
Conclusion: The evolving landscape in healthcare financing requires more preparation among our medical students and trainees. Innovative strategies such as role-playing activities and guided reflection are useful in demonstrating economic factors that influence health and promote better understanding of externalities that shape the health status of individuals and communities.

Keywords: education, teaching, simulation training, social determinants of health

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