Inclusion of the homeless in health equity curricula: a needs assessment study

Abstract

Exposure to homeless patients is a potential strategy to teach about social determinants of health and health inequities. Little is known about student attitudes and preferences for learning about the homeless in curricula addressing vulnerable populations. A needs assessment to determine student readiness may inform strategies for teaching. A mixed-methods study of one matriculating physician assistant student class, with a cross-sectional survey and 3 focus groups (FG). The validated 19-item Health Professionals' Attitudes Toward Homelessness inventory (HPATHI) and new 7-item Learning Attitudes scale were administered to explore perceptions and preferences about relevance of caring for the homeless to future practice. FGs were conducted to theme saturation. Verbatim transcripts were independently read and coded by 3 researchers using constant comparison. Survey response rate was 100% (N = 60). Overall HPATHI mean score was 3.97 ± 0.04 of 5, indicating positive attitudes toward the homeless. The highest mean score (4.26 ± 0.04) was for the social advocacy subscale; the lowest (3.02 ± 0.06) for personal advocacy. The Learning Attitude scale (Cronbach's alpha 0.89) mean score was 4.47 ± 0.07 out of 5, showing a positive attitude toward curricular exposure. Older students and those with prior experience with the homeless had higher HPATHI scores (p < 0.05). Four major themes emerged: vulnerable patients cannot advocate for themselves; learning about homelessness is relevant to future practice; preference for multiple teaching strategies and adequate preparation for street rotations; and anticipated anxiety about safety. Students recognize the value of learning from homeless patients as part of gaining skills in caring for vulnerable populations. Experiential learning opportunities focusing on this group are seen as an acceptable and valuable way to gain skills applicable to all vulnerable patients. Students express fear and anxiety around non-traditional settings such as the street. Their anxieties should be adequately addressed when designing clinical rotations.

A Street Psychiatry Rotation for Medical Trainees: Humanizing the Care of People Experiencing Homelessness

“…The quantitative data from this pilot survey has limited ability to be compared with other HPATHI data due to both our small sample size and the fact that only 12 of the questions on our survey were taken from the HPATHI's 19 questions. Our overall mean of 4.44 is slightly higher than the mean from first-year physician assistant students before exposure to any curriculum, which was 3.97 [7]. As a comparison, another study's average HPATHI score for students and residents with more than 1 year working with people experiencing homelessness was 4.01 [6].…”

“…Health professionals and trainees with more than 1 year of experience working with people experiencing homelessness had significantly higher HPATHI scores [6]. Physician assistant students who had worked previously with people experiencing homelessness scored higher on the HPATHI than those who did not [7]. In another study, a larger proportion of residents in one program entered a public psychiatry fellowship after a rotation about homelessness was implemented, suggesting that trainees may even steer their careers toward community work after these rotations end [8].…”

A response to ‘inclusion of the homeless in health equity curricula: a needs assessment study’

“…We read with great intrigue this paper by Feldman et al [1]. It highlighted an important, yet often neglected topic in healthcare education.…”

“…One way this can be addressed is by encouraging student involvement in programmes such as 'Street Medicine', a well-known concept in the US but one that requires expansion in the UK. As prefaced by 'FG B, Student E' [1], this would be an effective teaching method as healthcare students would be learning from the experienced leaders of the roaming medical teams and just as with other clinical placements, learning is often maximised when thrown into the deep end and dealing directly with patients. An important component of the delivery of this teaching not touched on in the article is having debrief sessions after the placements.…”

A UK medical student’s view to ‘inclusion of the homeless in health equity curricula: a needs assessment study’

“…As 5th-year medical students in Manchester, we enjoyed reading Feldman et al’s article exploring attitudes to the inclusion of homelessness in the medical curriculum [ 1 ]. Manchester, like many parts of the UK is experiencing a homelessness crisis and our joint involvement in homeless healthcare initiatives meant we wanted to offer our perspective on the matter.…”