Student-Run Free Clinic Integration into Medical School Curriculum: Impact on Medical Students’ Attitudes Towards the Houseless Before and After Participating in Direct Patient Care

Abstract

Introduction: The O‘ahu Point in Time Count is an annual street and shelter count which measures the number of people experiencing houselessness[1] on a single night in January. In 2024, 4,494 individuals were identified as houseless across O‘ahu; 51% identified Native Hawaiian/Pacific Islander (NHPI) as either their only race or part of a multiracial identity. Houselessness continues to be a prominent social issue in Hawai‘i, especially for NHPI populations, and remains an important factor of consideration in working to improve health equity for the local community.

In response to this long-standing, continually growing gap in health equity, the Hawai‘i Houseless Outreach and Medical Education (H.O.M.E.) Project serves to improve quality access to healthcare for individuals experiencing houselessness while increasing student and physician exposure and understanding of the houseless population and their healthcare needs. H.O.M.E. Project provides free medical services to houseless individuals through multiple weekly student-run free clinics at various sites across O‘ahu.

Since 2021, H.O.M.E. Project has been formally integrated into both the pre-clerkship and clerkship curriculum for all medical students at the John A. Burns School of Medicine (JABSOM) with the intent of providing all students with more opportunities to understand, advocate for, and apply the impact of social determinants of health to patient cases and outcomes. The goal is with repeated opportunities for hands-on learning, students gain experience and confidence in their ability to empathize with and deliver equitable care to diverse and vulnerable patient populations.

Objectives: The objective of this study is to evaluate the efficacy of curriculum integration of H.O.M.E. clinic on students’ knowledge, skills, comfortability, and efficacy when working with the houseless community.

Methods: 77 medical students at JABSOM who experienced first-year clinical experiences with H.O.M.E clinic were asked to complete pre-surveys at the start of the school year and post-surveys immediately after completion of first year. Surveys assessed students’ pre and post knowledge and attitudes towards houselessness as a result of participation in H.O.M.E. clinic. To compare differences in pre- and post-survey responses, paired t-test was used. Statistical analyses were performed using version 4.2.0 of R software.

Results: Of 77 total medical students, 66 completed both pre- and post-surveys. 42% (n=28) held leadership roles during their H.O.M.E. Project experience. Results illustrated a significant increase in confidence among students’ knowledge of issues faced by the houseless community and availability of local aid resources (p<0.001). Data also showed significant increase in skills such as working with others, navigating difficult patient interactions, managing patient expectations, and interacting with patients using a trauma-informed lens (p<0.05).

Discussion: Based on data thus far, H.O.M.E. Clinic integration into curriculum has a statistically significant impact on student’s knowledge, skills, comfortability, and efficacy when working with the houseless community. Further evaluation is needed to better understand the strengths, challenges, and limitations of the impact of curriculum integration. Future investigation includes expanding the survey to additional cohorts of students, and conducting similar studies with students of other backgrounds (social work, nursing, etc) to evaluate impact on their learning.

Target Audience: Health professions educators interested in incorporating diversity, equity, inclusion, and social justice into curricula

References: 1. 2024 Homeless Point in Time Counts – Hawai’i Health Data Warehouse. Hhdw.org. Published September 4, 2024. https://hhdw.org/na-2024-homeless-point-in-time-counts/ 2. Matters HH. Hawaii Health Matters :: Resource Library :: 2024 Point in Time Count. Hawaiihealthmatters.org. Published 2024. https://www.hawaiihealthmatters.org/resourcelibrary/index/view?id=33623032766485311