Teaching curriculum for medical students to address health disparities among the homeless

Background

Millions of American experience homelessness in the US, annually. Medical providers don’t generally receive targeted training in regards to healthcare for the homeless contributing to significant health disparities among the homeless.

Methods

A comprehensive 4-week curriculum with didactic, clinical and analytic components was developed and offered to medical students to improve their attitude and skills in working with the homeless and to address their health disparities. The curriculum covered clinical, social causes and advocacy, and public health and policy competencies. Students learned how to elicit relevant social history; assess barriers to access to healthcare and the homeless patient’s health expectation; perform clinical evaluation of medical conditions specific to the homeless; develop customized plan of care tailored towards individual patient medical and social needs while precepted by faculty; collaborate with dedicated support staff and community organizations to improve adherence and medical care; and engage in broader advocacy for the homeless. Elective opportunities for mentored research projects were provided.

Results/Evaluation

Between 2012 to 2013, we assessed trainees (n=30) feedback and satisfaction using semi-structured interviews and debriefing sessions, and their knowledge, attitude and skills using pre- and post-curriculum questionnaires coupled with faculty final evaluation of history taking, physical exams, and communication skills. Trainees rated the overall quality and usefulness of the curriculum and practice-based teaching as “very good to excellent”. Final evaluations of clinical and communication skills by the faculty were overwhelmingly positive and majority were rated as “outstanding rapport with patients.” The students’ overall skills in evaluation of physical and mental health issues as well as substance abuse and other risky behaviors improved significantly comparing to pre-curriculum (p<0.05). The baseline attitude towards working with the homeless was generally high (on average 3.5 in scale of 1 to 5) and while improved from the baseline it was not significant. The curriculum achieved its educational objectives, was feasible to implement, and will likely lead to improved medical care to the homeless addressing their considerable health disparities. Comprehensive and ongoing clinical component in shelter-based clinics, diverse teaching methods, experienced faculty, and collaboration with community organizations were key factors.