266 Implementing a Community Engagement Program for Residents at an Urban Emergency Department

Abstract

Patients within urban underserved communities who present to the emergency department (ED) face many systemic factors that affect their health including documentation status, food insecurity, violence and homelessness. Resident learners caring for this population can find it challenging to address these issues. As part of a larger social emergency medicine (EM) curriculum we designed a “Day of Service” for residents to engage with community-based organizations that serve our patients. Our objectives were to describe implementation of a community engagement program for resident learners at an urban ED, describe resident-perceived utility of this program to care for patients and self-rated efficacy in caring for patients after participating in the program. We implemented a “Day of Service” during our weekly educational conference over the course of five hours. We arranged for site visits with four different community-based organizations that provide services including tattoo removal for former gang members, shelter and food services for persons with housing instability, legal services for undocumented persons, resources for victims of violence and sexual assault and primary care for homeless persons. A total of 24 residents (years one through four) participated. A post-“Day of Service” survey was sent to all participants with the following Likert scale items: 1) How useful was the experience in caring for patients in the ED? 2) The experience equipped me with ideas to contribute to patients’ health via partnerships outside of the ED. 3) I would like to have more experiences like this incorporated into my residency education. A total of 9 residents participated in the post-survey (total sample size n=9). In response to the first item, 78% (n=7) of respondents found the experience very or extremely useful while 22% (n=2) found the experience somewhat useful. For the second item 89% (n=8) agreed or strongly agreed that the experience equipped them with ideas to contribute to patients’ health via partnerships outside of the ED while 11% (n=1) disagreed. And for the remaining item 89% agreed or strongly agreed that they would like to have more experiences like this incorporated into their residency education while 11% (n=1) disagreed. We were able to successfully implement a “Day of Service” as part of our larger social EM curriculum for residents at an urban ED. Residents felt the experience was overall useful in caring for patients in our ED, felt better equipped to provide community-based resources that contribute to the health of our patients and would like to have similar experiences incorporated into their residency education. The free text sentiments also supported these sentiments, with emphasis on the importance of experiential learning and patient voice to guide and motivate social EM curriculum. We suspect our small survey sample size was due to the emailed electronic format. We plan to have a “Day of Service” similar to this one twice an academic year and will ask participants to fill out paper evaluations on the day of the program to increase our evaluation data. While our sample size was small, we believe these results demonstrate the utility of a community engagement program for residents to alleviate some of the challenges and frustrations addressing systemic factors that affect patients’ health at an urban ED.