The Development and Efficacy of a Healthcare for the Homeless Undergraduate Medical Education Elective

Introduction: Street medicine is practiced around the country to provide healthcare for patients experiencing homelessness, but few formal options exist for educating health-allied professionals on how to provide high-quality healthcare to unhoused patients within medical education. Methods: A student-initiated street medicine organization developed and implemented a curriculum that combines self-directed online learning with street-based education. Clinical students (third- and fourth-year students) enrolled in our program, which included self-paced online didactics, personal reflection exercises, clinical street experiences, and curriculum-based near-peer “car talks” to promote personal reflection and active learning. Didactic elements were used for all learners, and clinical and precepting components were used in conjunction with the online curriculum. To evaluate the effect on medical student attitudes towards individuals experiencing homelessness, students completed the Health Professionals’ Attitudes Toward the Homeless Inventory (HPATHI) before and after the elective.1 Results: Twelve students completed the four-week elective at the University of Michigan Medical School over a period of 24 months. Of the 10 students who completed the pre- and post-course surveys, statistical analysis (single-factor analysis of variance [ANOVA]) showed 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 total HPATHI score (F=11.79, P<0.01). Conclusion: The online modules and service-learning activities used in this elective provided exposure to street medicine for healthcare professionals, resulting in improved attitudes toward individuals experiencing homelessness. While individual community partners and service-learning activities may vary, this model may serve as a framework for other medical schools to develop their street medicine electives.