A collaborative clinical and population-based curriculum for medical students to address primary care needs of the homeless in New York City shelters: Teaching homeless healthcare to medical students

To describe epidemiology of homelessness, recognize it as a social problem with health implications, and understand the role of fundamental causes of diseases

Readings

Discussion sessions

Lectures

To demonstrate skills to investigate and evaluate psychosocial components/stressors of their patients illness

Clinical sessions

Clinical precepting

To develop skills to address biomedical problems specific to homeless population including but not limited to consequences of substance abuse, living on streets or in transitions or in shelters

Targeted readings

Clinical sessions

Clinical precepting

To recognize and address barriers to healthcare access among homeless population (health system level, individual levels, and provider competency level)

Targeted readings

Discussion sessions

Lectures

To develop skills to efficiently use the primary care setting and its resources to address patient’s socio-medical conditions effectively

Targeted readings

Clinical sessions

Team discussion

To recognize and apply patient-centred approach considering patient’s priorities

Discussion sessions

Clinical precepting

Lectures

To develop skills in efficient use of time in primary care setting and apply evidence-based approaches to medical conditions of homeless

Clinical sessions

Clinical precepting

To demonstrate skills in working collaboratively with community and grass-root organizations that provide services to homeless and to learn effective team work with case workers, support staff and shelter staff

Team discussion

Clinical precepting

To develop skills in recognizing and directing patients to appropriate mental health and substance abuse programmes

Targeted readings

Clinical sessions

Clinical precepting

To develop skills in efficient use of time in primary care setting and apply evidence-based approaches to medical conditions of homeless

Readings

Clinical precepting

KNOWLEDGE

Composite score (Yes/No, or one correct answer)

0.2822

0.0325

18

0.422

0.022

15

p < 0.001

What is the average number of homeless persons who sleep on street each night in New York City?

a) 20,000 b) at least 10,000 c) 3–4,000 d) I have no idea

0.17

0.09

18

0.87

0.09

15

p = 0.001

What is the percentage of family homelessness among homeless population in the United States?

a) 15–25 % b) 30–40 % c) 50–70 % d) I have no idea

0.11

0.08

18

0.33

0.13

15

p = 0.082

What is among some of the most common complaints in dropping centres?

a) Headache b) abdominal pain c) cough d) feet swelling

0.08

0.08

13

0.62

0.15

13

p = 0.015

The highest cost of homeless to society comes from?

a) Social services b) food and housing c) outpatient care d) hospital admission due to mental illness

0.79

0.11

14

0.92

0.08

13

p = 0.081

What is the ethnicity/race with highest rate of homelessness among chronically homeless in New York City?

a) Black b) Hispanic c) Whites d) other e) all are equally at risk

0.53

0.12

17

0.80

0.11

15

p = 0.040

ATTITUDE

Composite score ^a

3.35

0.063

18

3.65

0.056

15

p < 0.001

I am comfortable being a primary care provider for a homeless person with major mental illnesses

2.81

0.22

22

3.94

0.11

16

p = 0.001

I feel comfortable providing care to different minority and cultural groups

4.10

0.22

22

4.38

0.18

16

p = 0.029

I feel generally overwhelmed by the complexity of the problems that homeless people have

3.33

0.17

22

2.56

0.18

16

p = 0.003

I enjoy learning about the lives of my homeless patients

3.90

0.17

22

4.63

0.13

16

p = 0.003

I generally believe caring for the homeless is not financially viable for my career

2.95

0.18

22

2.56

0.26

16

p = 0.096

I feel comfortable to provide care to a homeless person with depression

3.14

0.19

22

4.13

0.09

16

p = 0.0001

I feel comfortable to provide care to a homeless person with other mental illnesses

2.90

0.19

22

4.13

0.09

16

p = 0.0001

I feel comfortable to provide care to a homeless person with substance abuse

2.81

0.16

22

3.81

0.14

16

p = 0.0001

I feel comfortable to provide care to a homeless person with alcohol abuse

2.76

0.15

22

3.94

0.14

16

p = 0.0001

I feel comfortable to help uninsured or underinsured persons to better navigate health system

2.33

0.20

22

3.25

0.19

16

p = 0.021

I feel comfortable to negotiate plan of care with homeless patients considering their constraints and expectations

3.05

0.18

21

4.00

0.20

16

p = 0.006

Composite score ^a

3.317

0.067

18

3.695

0.061

12

p < 0.001

I believe that I can assess depression in a homeless person

3.33

0.20

21

4.44

0.13

16

p = 0.0002

I believe that I can apply Depression score/questionnaire to assess depression in a homeless person

3.62

0.18

21

4.69

0.12

16

p = 0.0009

I believe that I can obtain and assess psychosocial issues from a homeless person

3.43

0.15

21

4.25

0.14

16

p = 0.0004

I believe that I can assess substance abuse in a homeless person

3.43

0.18

21

4.06

0.19

16

p = 0.014

I believe that I can assess alcohol abuse or dependence in a homeless person

3.48

0.16

21

4.19

0.14

16

p = 0.002

I believe that I can obtain and assess sexual history from a homeless person

3.95

0.08

21

4.44

0.13

16

p = 0.0004

I believe that I can assess smoking history and provide smoking cessation to a homeless person

3.86

0.13

21

4.56

0.13

16

p = 0.0003

I believe that I have skills in directing homeless persons to potential psychosocial resources

2.24

0.14

21

3.57

0.22

16

p = 0.002

I believe that I have skills in directing homeless persons to potential and accessible biomedical resources

2.24

0.15

21

3.38

0.18

16

p = 0.0001

I believe that I can work collaboratively with social service providers and community organizations that provide services to the homeless

3.95

0.18

21

4.38

0.13

16

p = 0.047

I believe that I have clinical skills to detect and address most medical problems specific to the homeless population

2.95

0.16

21

4.06

0.11

16

p = 0.0001

How has your experience here at Community Medicine Program changed your career choices to go to: Primary care residencies (Emergency Medicine, Internal Medicine, Paediatrics, OBGYN, Preventive Medicine, Family Medicine, General Surgery)

3.11

0.11

9

3.56

0.16

16

p = 0.078

How has your experience here at Community Medicine Program changed your career choices to work with the underserved?

3.22

0.22

19

4.13

0.15

16

p = 0.011