An Experiential Community Orientation to Improve Knowledge and Assess Resident Attitudes Toward Poor Patients

Abstract

Background Future physicians may not be prepared for the challenges of caring for the growing population of poor patients in this country. Given the potential for a socioeconomic “gulf” between physicians and patients and the lack of curricula that address the specific needs of poor patients, resident knowledge about caring for this underserved population is low. Intervention We created a 2-day Resident Academy orientation, before the start of residency training, to improve community knowledge and address resident attitudes toward poor patients through team-based experiential activities. We collected demographic and satisfaction data through anonymous presurvey and postsurvey t tests, and descriptive analysis of the quantitative data were conducted. Qualitative comments from open-ended questions were reviewed, coded, and divided into themes. We also offer information on the cost and replicability of the Academy. Results Residents rated most components of the Academy as “very good” or “excellent.” Satisfaction scores were higher among residents in primary care training programs than among residents in nonprimary care programs for most Academy elements. Qualitative data demonstrated an overall positive effect on resident knowledge and attitudes about community resource availability for underserved patients, and the challenges of poor patients to access high-quality health care. Conclusions The Resident Academy orientation improved knowledge and attitudes of new residents before the start of residency, and residents were satisfied with the experience. The commitment of institutional leaders is essential for success.

Living with poverty: A simulation

“…Although students from programmes designed for public service, such as nursing or social work, are positioned as ideal participants (Jarrell et al, 2014;Vandsburger et al, 2010), it is likely that students from other disciplines and professions would benefit from exposure to poverty awareness activities. Indeed, experiential learning on poverty has been suggested as a means to improve medical residents' knowledge of patients living in poverty (Wallace et al, 2013), equip pre-service teachers with a better understanding of future students who may be experiencing poverty (Catapano & Huisman, 2010) and encourage business students to think about how poverty, and the constraints associated with it, affects people in the marketplace (Viswanathan, Yassine, & Clarke, 2011).…”

“…the Missouri Association for Community Action's Poverty Simulation (e.g. Strasser, Smith, Denney, Jackson, & Buckmaster, 2013;Wallace, Miller-Cribbs, & Duffy, 2013) and its adaptions, e.g. the Oregon Poverty Simulation (Bowman, Bairstow, & Edwards, 2003); Development Monopoly (Ansoms & Gennen, 2012); the poverty simulation in Second Life V R (Menzel, Willson, & Doolen, 2013) and the modified 'Paper Bag Game' (Davidson, DuPreez, Gibb, & Nell, 2009).…”

Childhood Poverty and Its Effect on Health and Well-being: Enhancing Training for Learners Across the Medical Education Continuum

“…10,11 Pediatric residents who learn the concepts of social determinants and the skills of community engagement are more likely to continue these behaviors throughout their career. 12,13 Current training to address the health effects of poverty has been recently developed in pediatrics 10,[14][15][16] and new models in internal medicine are emerging. 17 These important early examples vary widely in content, depth, and delivery, which undermine systematic and broad dissemination.…”

Poverty, Health, and Graduate Medical Education

“…The work of Wallace and colleagues 12 further adds to existing evidence that educational interventions may improve resident knowledge and attitudes toward vulnerable patients and populations. The next step in demonstrating the role for medical education in the realm of the social determinants of health is to link educational interventions to clinical outcomes and patient-reported outcomes.…”

“…To this point, there is increasing focus among professional societies on training residents and fellows to effectively care for these patients, and the Accreditation Council for Graduate Medical Education stresses that one role of the Next Accreditation System is ''to arm the next generation of physicians with knowledge, skills, and attributes that will enhance care in the future and to expand the traditional role of residents in the care of underserved populations. '' 11 In this issue of JGME, Wallace and colleagues 12 describe an experiential curriculum aimed at improving knowledge and attitudes of incoming residents toward patients living in poverty. The curriculum was delivered to incoming residents across several disciplines during 2 days of residency orientation.…”