Development, Integration, and Evaluation of Street Medicine Into Emergency Medicine Resident Education

Abstract

Background

People experiencing homelessness (PEH) utilize the emergency department (ED) at higher rates than the general population. Emergency medicine (EM) physicians would benefit from increased exposure to homeless healthcare, including street medicine, which provides mobile care to PEH. Thus, leveraging a relationship with a local healthcare organization for the homeless, this project aimed to implement a street medicine experience for first-year EM residents and evaluate resident perceptions of the experience.

Methods

By partnering with an existing street medicine program, we piloted an elective one-day experience for first-year EM residents. Residents were invited to complete pre- and post-experience surveys using the Health Professionals' Attitude Toward the Homeless Inventory (HPATHI), augmented with additional Likert scale and qualitative questions. We calculated descriptive statistics and performed analysis of free-text answers using inductive and in vivo codes.

Results

We successfully piloted and integrated a street medicine experience into the curriculum of an EM residency program. 17/17 (100%) residents of the first-year class participated in the elective. 13/17 (76%) of residents completed the pre-survey and 9/17 (53%) of residents completed the post-survey. Although there were no statistical differences between pre- and post-surveys, major themes from free text responses included (1) practice-changing insights into systems- and community-based challenges within the lived experiences of PEH, and (2) interest in additional education dedicated to street medicine. On average, residents found the experience to be useful (mean 4.0, standard deviation [SD] 1.40) and valuable (mean 4.4, SD 1.01), felt more comfortable caring for PEH (mean 4.6, SD 0.73), and had a better understanding of community resources (mean 4.6, SD 0.73) after the experience.

Conclusion

We demonstrated the feasibility of incorporating a street medicine pilot experience into EM resident education, and, on average, residents perceived this experience as a valuable and useful addition to their education.