We assessed the impact of a 2-week required rotation in homeless health care on primary care residents' attitudes toward homeless people. Attitudes were assessed before and after the course using the Attitudes Toward Homelessness Inventory (ATHI), an instrument previously validated among undergraduate students. Attitude scores on the ATHI improved from 46 to 52 (range of possible scores 11 to 66; P =.001). The ATHI subscales showed, after the course, that residents had a greater belief that homelessness had societal causes and felt more comfortable affiliating with homeless people. After the course, residents also reported an increased interest in volunteering with homeless populations on an anonymous survey.

OBJECTIVE:Previous studies have shown that most medical inpatients receive treatment supported by strong evidence (evidence-based treatment), but they have not assessed whether and how physicians actually use evidence when making their treatment decisions. We investigated whether physicians would change inpatient treatment if presented with the results of a literature search.DESIGN: Before-after study. SETTING: Large public teaching hospital.PARTICIPANTS: Random sample of 146 inpatients cared for by 33 internal medicine attending physicians. INTERVENTIONS:After physicians committed to a specific diagnosis and treatment plan, investigators performed standardized literature searches and provided the search results to the attending physicians. MEASUREMENTS AND MAIN RESULTS:The primary study outcome was the number of patients whose attending physicians would change treatment due to the literature searches. However, to conclude from these studies that most medical inpatients receive evidence-based treatment is potentially misleading.9,10 None of the studies assessed whether or how physicians actually used evidence when making their treatment decisions. Nor did they determine whether, as a result, patients received the best available treatment. (For particular patients, some evidence-based treatments are better than others.) All of these considerations -physicians' judgments, patients' unique clinical circumstances, and the evidence relevant to various treatment options -are essential to the practice of evidencebased medicine. 11In order to explore these important issues further, we sought to measure the potential efficacy of actually practicing evidence-based medicine. In the present study, we assessed the impact of standardized literature searches on attending physicians' treatment decisions for medical inpatients. METHODS Study DesignWe performed a before-after study of physicians' treatment decisions for a random sample of patients admitted to a general medicine inpatient service at one hospital. Before performing a standardized literature search, we elicited from the attending physician the patient's primary clinical problem (the principal diagnosis requiring inpatient treatment) and the specific treatment being given for it. After searching the medical literature about the patient's problem, we presented the search findings to the attending physician and asked whether he or she would change the patient's treatment as a result of the literature search. Figure 1 outlines the study design within the conceptual framework of therapeutic decision making. This model assumes that physicians typically consider various treatment options before committing to a specific treatment. We hypothesized that a literature search would cause physicians to change their treatments if the search identified treatment options not previously considered or provided data that altered their evaluation of treatment options.

Both the ATHI and the ATHQ documented improvement in residents' attitudes after a 2-week homeless medicine curriculum. However, the ATHI was 4 times more responsive to change. These findings suggest that the ATHI is superior for detecting changes in attitudes after an educational intervention.