The Attitudes of Canadian Ophthalmology Residents and Pre-Clerkship Medical Students at an Ontario Medical School Towards Homeless Individuals: A Cross-Sectional Study

Abstract

Purpose: This cross-sectional study assessed the attitudes of Canadian ophthalmology residents (PGY1-5) and pre-clerkship medical students (year 1 and 2) at the University of Toronto towards individuals experiencing homelessness. Methods: Residents and students were invited to complete the Health Professionals' Attitudes Towards the Homeless Inventory (HPATHI) tool to assess attitudes, interests and confidence in working with the homeless population on a 5-point Likert scale. Comparisons were made between residents and pre-clerkship learners and between junior and senior residents using the Fisher exact test and Mann-Whitney U test. Results: Responses were received from 114 of 220 ophthalmology residents (52%) and 315 of 534 (59%) pre-clerkship medical students. Ophthalmology residents had significantly more negative overall attitudes (pre-clerk median = 4.4, resident median = 4.1, both still indicating positive attitudes) and interests (pre-clerk median = 4.0, resident median = 3.3, residents with more neutral interests) towards working with the homeless population compared to pre-clerkship medical students. Using both statistical methods, beliefs were significantly more negative in 7 of 9 'Attitude' items, 5 of 5 'Interest' items and 1 of 4 'Confidence' items. Ophthalmology residents were only more positive in 1 of 4 of the 'Confidence' items. Attitudes were similar across PGY1-5 training years, except PGY4 and PGY5 residents were more negative than PGY1-3 residents on 1 of 5 'Interest' items. Conclusions: Ophthalmology residents have an at least neutral perception of individuals experiencing homelessness, while medical students have a more positive opinion. Studies exploring optimal ways to advocate for this population are needed for Canada's eye-care trainees.

A scoping review of surgical care for people experiencing homelessness: prevalence, access, and disparities

“… 90 Both of these studies were published only as abstracts at the time of our review. A primary study by Sayal and colleagues 91 explored the attitudes of medical students and ophthalmology residents working with PEH. Residents had more negative attitudes, less interest, and less confidence working with PEH than medical students.…”

“…Residents had more negative attitudes, less interest, and less confidence working with PEH than medical students. 91 …”

“…Many studies discussed barriers or challenges PEH face when it comes to surgical care, including 48 primary studies, 19 , 31 , 34 – 36 , 39 – 41 , 43 – 45 , 47 – 50 , 54 , 55 , 57 – 64 , 66 , 69 , 72 , 73 , 75 , 79 – 81 , 86 , 91 , 96 , 98 , 100 , 102 – 105 , 107 – 109 , 111 , 112 , 114 , 116 9 abstracts, 37 , 38 , 42 , 52 , 77 , 84 , 101 , 106 , 118 5 literature reviews, 22 , 74 , 95 , 99 , 110 1 invited article, 51 1 magazine article, 70 1 thought piece, 92 1 ethical essay, 115 1 thesis, 71 and 1 historical analysis. 117 The majority of comments presented concerns regarding living conditions.…”

“… 59 , 80 , 100 , 114 , 115 Overall, PEH can have negative interactions with the health care system that lead to mistrust. 38 , 50 , 70 , 91 , 92 , 115 Additionally, studies commented on how the perceptions of PEH concerning social pressure in clinics, 41 embarrassment with procedures, 51 , 80 inability to pay, 70 , 72 and necessity of the operation 39 can act as barriers.…”

“…The single study that explored students’ and residents’ perceptions of working with PEH determined that attitudes appeared to become more negative as trainees progressed through training. 91 The teaching surrounding working with PEH has been called into question for reinforcing stereotypes and lacking applicability. 122 However, although only available in the form of abstracts, the studies that investigated educational initiatives found positive responses among the learners involved.…”