142nd APHA Annual Meeting and Exposition

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

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Ramin Asgary, MD, MPH , Depts of Medicine and Population Health, New York University School of Medicine, New York, NY
Blanca Sckell, MD, MPH , Community Medicine Program, Lutheran Family Health Centers, Brooklyn, NY
Analena Alcabes, BS , Medicine, New York University School of Medicine, New York, NY
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.

Learning Areas:

Clinical medicine applied in public health
Other professions or practice related to public health
Program planning
Public health or related education
Public health or related research
Social and behavioral sciences

Learning Objectives:
Discuss the components of a health disparities curriculum for medical students in regard to medical care for the homeless Design a teaching curriculum to address barriers to proper healthcare among the homeless Formulate the evaluation of a clinical training program in health disparities

Keyword(s): Health Disparities/Inequities, Curricula

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have extensive experience in health disparities research and teaching. I have developed curricula for medical students and residents in healthcare of the homeless, immigrants and refugees and published the results. I have designed and evaluate this curriculum and prepared the abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.