Homeless Health Care Simulated Patient Case

Abstract

OPEN ACCESSDecember 13, 2007Homeless Health Care Simulated Patient Case Susan Glick, MD, David Buchanan, MD, Louis Rohr, MD, Laura Kehoe, MD, MPH Susan Glick, MD University of Chicago Division of the Biological Sciences The Pritzker School of Medicine Google Scholar More articles by this author , David Buchanan, MD Rush Medical College of Rush University Medical Center Google Scholar More articles by this author , Louis Rohr, MD Rush Medical College of Rush University Medical Center Google Scholar More articles by this author , Laura Kehoe, MD, MPH Harvard Medical School Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.759 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: In order to appropriately care for a patient who is homeless, physicians must recognize the significance of homelessness to health and respond to the unique challenges that homelessness presents. Unfortunately, medical students and physicians rarely receive formal training in homeless health care. This simulated patient (SP) case aims to teach learners about the presentation, diagnosis, and management of homelessness and to evaluate their skill in recognizing, screening for, and responding to patients who are homeless. Methods: The program was held in a SP laboratory. Learners attended the program in groups of four. Learners were first oriented to the program before independently evaluating the SP and documenting the history, physical examination, assessment, and plan in a written clinic note. After the evaluation a faculty preceptor led a postclinic conference. Results: Twelve primary care internal medicine residents participated in this case. Of these, seven found the case highly educational and five found it very educational; seven found the case highly realistic and five found it very realistic. Eleven of the residents recommended that the residency program offer another SP program in the future. Of the twelve residents, four had participated in a required rotation in homeless health care, and eight had received no formal training in homeless health care but had extensive experience caring for homeless patients in a large, urban public hospital/clinic. Of the four residents with extensive instruction, three (75%) recognized the relationship between homelessness and diabetes control and asked about this explicitly. These three residents (75%) gave the patient suggestions about how and where to store his insulin. Three of the residents (75%) referred the patient to the social worker. Of the eight residents without formal training, only four (50%) recognized the relationship between homelessness and diabetes control and asked about this explicitly. None of the residents provided the patient with suggestions about how and where to store his insulin. Seven of the residents (88%) referred the patient to the social worker. Discussion: Primary care internal medicine residents without formal training in homeless health care are less likely to appreciate the relationship between homelessness and control of chronic illness, and are less likely to incorporate homelessness into their management plans. Both groups of residents (those with and those without formal training in homeless health care) recognize the need to refer patients who are homeless to a social worker. The apparent belief that responding to homelessness is the responsibility of the social worker and not necessarily the physician may result in a missed opportunity to improve the care of chronic disease for patients who are homeless. Educational Objectives By the end of this session, learners will be able to: Recognize the impact of homelessness on the control and management of chronic disease.Recognize that homeless people must have primary care issues addressed whenever they present to the clinic because they often miss scheduled appointments.Incorporate the challenges posed by homelessness into the management plan.Respond appropriately to patients who are homeless, including offering referrals to a social worker where appropriate. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Homeless Health Care SP Case.pdf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2007 Glick et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsHealth Equity ResearchSPsHomeless PersonsSocial WelfareSocial WorkUrban HealthDiabetes MellitusVulnerable Populations Disclosures None to report. Funding/Support None to report. Prior Presentations Glick SB, Lemon M. Beyond “Call Social Work”: a simulated patient program to improve residents' ability to care for vulnerable populations [Society of General Internal Medicine National Meeting, Poster, Vancouver, British Columbia, Canada]. J Gen Intern Med. 2003;18(Suppl 1):109. Glick S, Abrams R, Buchanan D, Cohen M, Francis L, Lemon M, McAuley J, Riordan K, Rohr L, Smith J, Whitaker E. Teaching and learning about vulnerable populations. Half-day presession at: Society of General Internal Medicine National Meeting; 2002; Atlanta, GA. Loading ...