Healthcare for the Homeless: Development and Implementation of a Medical Education Elective

Abstract

Background In response to the healthcare needs of patients experiencing homelessness, there has been a growing interest in street medicine to provide healthcare services to this vulnerable population. However, formal education on high-quality healthcare for unhoused individuals remains limited in medical education.

Actions, Methods, or Interventions A student-initiated street medicine organization developed and implemented a curriculum to leverages a combination of self-directed online learning and street-based education. Clinical students in their third and fourth years of medical school participated in this program, which encompassed self-paced online didactics, personal reflection exercises, clinical street experiences, and curriculum-based near-peer “car talks” (Table 1). The didactic elements of the curriculum are designed to benefit all learners (Table 2), and the clinical and precepting components complement the online experiences.

Results Over a 24-month period, 12 students completed a 4-week elective. Among the 10 students who completed both pre- and post-course Health Professional’s Attitudes Toward the Homeless Inventory (HPATHI) surveys (Table 3), statistical analysis revealed significant improvements in personal advocacy (F=7.57, P<0.05), social advocacy (F=6.49, P<0.05), cynicism (F=6.23, P<0.05), and the total HPATHI score (F=11.79, P<0.01) (Table 4; Figure 1).

Lessons Learned The combination of online modules and service-learning activities in the elective improved students' attitudes toward individuals experiencing homelessness. The success of this program demonstrates the potential for positive change in the perceptions and advocacy of future healthcare professionals. This approach also highlights the importance of addressing disparities in medicine and fostering empathy among medical students.

Future Application and Next Steps The model developed in this study offers a promising framework for other medical schools seeking to establish their own street medicine electives in collaboration with their own community partners. By adapting and implementing similar programs, medical schools can contribute to changing the narrative around homelessness and promoting compassionate healthcare practices. Next steps involve refining and expanding this curriculum and evaluating its impact on a larger scale. This approach has the potential to help produce a generation of healthcare professionals with improved attitudes and advocacy for those experiencing homelessness.