MedEdPORTAL (Nov 2015)
Healthcare for the Homeless Curriculum
Abstract
Abstract Introduction Medical schools and residency training programs need to graduate future physicians who are comfortable providing care to underserved and marginalized populations. Despite a national homeless population of more than 500,000 individuals, most institutions have no formal instruction on caring for this vulnerable population. This resource arose from a perceived need for such a curriculum after more than 90% of learners endorsed having provided care to a homeless individual in an institutional needs assessment. The curriculum can be used for learners at the medical school, internship, or residency (internal medicine or family medicine) level. Methods The curriculum contains didactic elements that can be used for all learners and clinical/precepting components to be used in conjunction with clinical experiences. The components include the Healthcare for the Homeless Didactic (in 1-hour and 2-hour PowerPoint formats), the homeless resources handout, educational cards, a preceptor/learner guide, and Adapting the Curriculum for Local Resources, a guide to identifying community/state resources for homeless persons to plug into the homeless medicine guide, resource handout, and didactic sessions. Results More than 200 students and more than 30 interns/residents have now completed the curriculum. Using pre− and posttests, we have seen large improvements in cognitive outcomes and smaller (but still statistically significant) improvements in attitudinal outcomes. As an example, less than 20% were able to help a homeless person access the shelter system before the curriculum, as compared with more than 70% a month after their ambulatory care clerkship. Similar gains were seen on other cognitive objectives, including knowledge of basic statistics, basic resources such as Medicare and Medicaid, and medical knowledge topics such as PPD interpretation and management. In pretesting, 71% of learners believed that learning about the care of homeless persons was applicable to their training, as compared to 90% in posttesting. Discussion The curriculum received very high marks in feedback from learners, and the didactic session is one of the highest rated of the clerkship. In both pre− and posttesting, more than 90% of learners believed that learning about the care of homeless persons was an important component of medical education and indicated interest in learning more about how to care for homeless persons.
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