Intern orientation is a place for residency programs to establish shared values, program expectations, and institutional priorities. It is also an opportunity for members of an intern class to spend meaningful time together. Additionally, understanding their future patients' communities and local resources is important to understanding patients' social determinants of health (SDoH). Rapidly building interns' knowledge around these key principles is a challenge, especially via experiential learning. Over a decade ago, our program began an orientation exercise with the goal of introducing interns to the community. This day is attended by all 23 interns in our program (8 internal medicine, 8 psychiatry, 7 transitional year). In 2019, we updated it to include a more explicit focus on SDoH. In 2020, we adapted the exercise to adhere to COVID-19 social distancing guidelines.

Our first day of orientation is dedicated to relationship-building among interns and program leadership; the afternoon of this day consists of a “Neighborhood Exploration” exercise (Table). The session begins with a presentation introducing interns to the demographics, health statistics, and health concerns of residents of the city where they will train. We also summarize SDoH and introduce our institution's SDoH screening forms. The interns are divided into groups and each group is assigned an SDoH component (housing, employment, food, transportation, or pharmacy) and given a relevant destination to walk to (ie, elderly/disabled housing complex, grocery store, subway station). Interns can opt-out if they have physical barriers to the activity. They are also provided with a local interest news article about their respective location or SDoH topic; examples of articles include coverage of a local labor dispute and interviews with tenants about rising housing costs and displacement. Interns then walk to and from the destination, observe the neighborhood, introduce themselves to people if appropriate, and take photos. The full group reconvenes on campus. Program leadership shares each group's photos and invites group members to share their observations in a closing reflection.

In 2020, we adjusted this exercise for the COVID-19 era. The introduction to the exercise and closing reflection occurred remotely. Interns traveled to the hospital and met their groups for the exploration after the introduction. Smaller groups were used this year to allow for social distancing, and masks were required.

Feedback was gathered via an end-of-day feedback form, with a 5-point Likert scale grading satisfaction for each activity and opportunities for open-ended comments.

In 2020, 15 out of 17 interns who filled out the survey rated the exercise 4 or 5 out of 5 on a satisfaction scale. Three of 12 interns who listed a favorite activity for the day listed the Neighborhood Exploration. Qualitative feedback included: “The exploration activity was very useful in both getting to learn more about the surrounding community and learning about my co-interns,” and “It was good to learn about the neighborhood and the neighborhood resources,” suggesting the activity met its goals. Prior feedback that the walking destinations were too far away led to changes in the destinations 2 years ago.

This exercise can easily be adapted to programs of any discipline. It would especially be of high value for community programs where the majority of patients live in the surrounding neighborhoods. It is easy to plan, requiring one faculty member with knowledge of the neighborhood who can assign walking destinations and introduce the exercise. This experiential learning exercise to reinforce SDoH concepts and introduce first-year residents to the neighborhood in which they will care for patients has been well received for many years, and it may be especially beneficial as COVID-19-related restrictions limit usual community activities.

Author notes

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Contributed equally to the work as co-senior authors.