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

Asgary, Ramin; Naderi, Ramesh; Gaughran, Margaret; Sckell, Blanca

doi:10.1007/s40037-016-0270-8

Cited by 25 publications

(30 citation statements)

References 20 publications

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“…Additionally, in-service curriculum focused specifically on health care for homeless persons might improve providers’ skills in communicating and developing rapport with homeless persons with MHSUDs. For example, one study found curriculum focused on health care for homeless persons increased providers’ understanding of challenges facing homeless persons, and improved providers’ communication skills and self-efficacy in managing care for homeless patients (Asgary, Naderi, Gaughran, & Sckell, 2016). …”

Section: Discussionmentioning

confidence: 99%

A national evaluation of homeless and nonhomeless veterans’ experiences with primary care.

Jones¹,

Hausmann²,

Haas³

et al. 2017

Psychological Services

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Persons who are homeless, particularly those with mental health and/or substance use disorders (MHSUDs), often do not receive continuous primary care services. In addition, negative experiences with primary care might contribute to homeless persons’ avoidance and early termination of MHSUD treatment. The patient-centered medical home (PCMH) model aims to address care fragmentation and improve patient experiences. How homeless persons with MHSUDs experience care within PCMHs is unknown. This study compared the primary care experiences of homeless and non-homeless Veterans with MHSUDs receiving care in the Veterans Health Administration’s medical home environment, called Patient Aligned Care Teams. The sample included VHA outpatients who responded to the national 2013 PCMH-Survey of Healthcare Experiences of Patients (PCMH-SHEP) and had a past-year MSHUD diagnosis. Veterans with evidence of homelessness (henceforth “homeless”) were identified through VHA administrative records. PCMH-SHEP survey respondents included 67,666 Veterans with MHSUDs (9.2% homeless). Compared to their non-homeless counterparts, homeless Veterans were younger, more likely to be non-Hispanic Black and non-married; had less education; and were more likely to live in urban areas. Homeless Veterans had elevated rates of most MHSUDs assessed, indicating significant co-occurrence. After controlling for these differences, homeless Veterans reported more negative and fewer positive experiences with communication; more negative provider ratings; and more negative experiences with comprehensiveness, care coordination, medication decision-making, and self-management support than non-homeless Veterans. Homeless persons with MHSUDs may need specific services that mitigate negative care experiences and encourage their continuation in longitudinal primary care services.

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Section: Discussionmentioning

confidence: 99%

A national evaluation of homeless and nonhomeless veterans’ experiences with primary care.

Jones¹,

Hausmann²,

Haas³

et al. 2017

Psychological Services

View full text Add to dashboard Cite

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“…All articles except for Powell and Bullock explicitly described programs that used traditional didactic forms of instruction [59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77]79 (20) and many described participatory components that were also classroom-based: case-based instruction 59,60,63,69,70,73,77 (7); small group work 61,63,69,77,80 (5); and peer teaching 59,66,67,71,78 (5). All learner-led activities were considered participatory within our charting scheme.…”

Section: Educational Methodsmentioning

confidence: 99%

“…Experiential learning was defined as activities involving direct interactions with patients, families, and communities. Clinic-based learning was integrated into clerkships or electives 59,66,67,71,78 (5). Community-based education took the form of service projects 61, 62, 65, 66, 68, 70, 71, 73-75, 78, 80 (12); community-based participatory research 62,74 (2); and neighborhood tours 69,72,75 (3).…”

Section: Educational Methodsmentioning

confidence: 99%

“…The final categories for program duration were short-term (≤ 6 weeks), intermediate (6 weeks-1 year), and longitudinal (> 1 year). Short-term interventions were either required as part of first year orientation or were a component of a longer clerkship 59,67,68,72,76 (5). Seven articles described intermediate initiatives ranging from a single course or clerkship 64,74,79 through programs that spanned months.…”

Section: Curricular Logistics: Timing Duration and Learner Charactementioning

confidence: 99%

“…Four other articles outlined SDH curricula for all medical students that were classified as short-term in duration. 59,68,72,76 The remaining 12 articles described selective or elective courses (Tables 1 and 2). 61-67, 70, 71, 73, 74, 78 It is notable that the learner characteristics sought by selective programs generally included a desire to work or experience working in resource-constrained settings, fluency in another language, interest in primary care, and strong service ethic.…”

Section: Curricular Logistics: Timing Duration and Learner Charactementioning

confidence: 99%

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Teaching the Social Determinants of Health in Undergraduate Medical Education: a Scoping Review

et al. 2019

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BACKGROUND: To provide optimal care, medical students should understand that the social determinants of health (SDH) impact their patients' well-being. Those charged with teaching SDH to future physicians, however, face a paucity of curricular guidance. OBJECTIVE: This review's objective is to map key characteristics from publications about teaching SDH to students in undergraduate medical education (UME). METHODS: In 2016, the authors searched PubMed, Embase, Web of Science, the Cochrane and ERIC databases, bibliographies, and MedEdPORTAL for articles published between January 2010 and November 2016. Four reviewers screened articles for eligibility then extracted and analyzed data descriptively. Scoping review methodology was used to map key concepts and curricular logistics as well as educator and student characteristics. RESULTS: The authors screened 3571 unique articles of which 22 were included in the final review. Many articles focused on community engagement (15). Experiential learning was a common instructional strategy (17) and typically took the form of community or clinic-based learning. Nearly half (10) of the manuscripts described school-wide curricula, of which only three spanned a full year. The majority of assessment was self-reported (20) and often related to affective change. Few studies objectively assessed learner outcomes (2). CONCLUSIONS: The abundance of initial articles screened highlights the growing interest in SDH in medical education. The small number of selected articles with sufficient detail for abstraction demonstrates limited SDH curricular dissemination. A lack of accepted tools or practices that limit development of robust learner or program evaluation was noted. Future research should focus on identifying and evaluating effective instructional and assessment methodologies to address this gap, exploring additional innovative teaching frameworks, and examining the specific contexts and characteristics of marginalized and underserved populations and their coverage in medical education.

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Association of a Health Equity Curriculum With Medical Students’ Knowledge of Social Determinants of Health and Confidence in Working With Underserved Populations

et al. 2021

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IMPORTANCE National organizations recommend that medical schools train students in the social determinants of health. OBJECTIVE To develop and evaluate a longitudinal health equity curriculum that was integrated into third-year clinical clerkships and provided experiential learning in partnership with community organizations. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study was conducted from June 2017 to October 2020 to evaluate the association of the curriculum with medical students' selfreported knowledge of social determinants of health and confidence working with underserved populations. Students from 1 large medical school in the southeastern US were included. Students in the class of 2019 and class of 2020 were surveyed at baseline (before the start of their third year), end of the third year, and graduation. The class of 2018 (No curriculum) was surveyed at graduation to serve as a control. Data analysis was conducted from June to September 2020. EXPOSURES The curriculum began with a health equity simulation followed by a series of modules. The class of 2019 participated in the simulation and piloted the initial 3 modules (pilot), and the class of 2020 participated in the simulation and the full 9 modules (full). MAIN OUTCOMES AND MEASURES A linear mixed-effects model was used to evaluate the change in the self-reported knowledge and confidence scores over time (potential scores ranged from 0 to 32, with higher scores indicating higher self-reported knowledge and confidence working with underserved populations). In secondary analyses, a Kruskal-Wallis test was conducted to compare graduation scores between the no, pilot, and full curriculum classes. RESULTS A total of 314 students (160 women [51.0%], 205 [65.3%] non-Hispanic White participants) completed at least 1 survey, including 125 students in the pilot, 121 in the full, and 68 in the no curriculum classes. One hundred forty-one students (44.9%) were interested in primary care. Total self-reported knowledge and confidence scores increased between baseline and end of clerkship (15.4 vs 23.7, P = .001) and baseline and graduation (15.4 vs 23.7, P = .001) for the pilot and full curriculum classes. Total scores at graduation were higher for the pilot curriculum (median, 24.0; interquartile range [IQR], 21.0-27.0; P = .001) and full curriculum classes (median, 23.0; IQR, 20.0-26.0; P = .01) compared with the no curriculum class (median, 20.5; IQR, 16.25-24.0). (continued) Key Points Question Is a longitudinal health equity curriculum associated with improved self-reported knowledge of the social determinants of health and confidence with working with underserved populations among US medical students? Findings In this cohort study of 314 students, self-reported knowledge and confidence scores significantly increased over time for participants in both the pilot and full curriculum classes. Compared with students not exposed to the curriculum, those in the pilot and the full curriculum classes had significantly higher scores at graduation. Me...

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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

Cited by 25 publications

References 20 publications

A national evaluation of homeless and nonhomeless veterans’ experiences with primary care.

A national evaluation of homeless and nonhomeless veterans’ experiences with primary care.

Teaching the Social Determinants of Health in Undergraduate Medical Education: a Scoping Review

Association of a Health Equity Curriculum With Medical Students’ Knowledge of Social Determinants of Health and Confidence in Working With Underserved Populations

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