Caring to Collaborate: Houseless Simulation in Interprofessional Education

Introduction: The houseless simulation exercise (HSE) is an innovative interprofessional education (IPE) online activity developed for health professional students to build awareness and empathy for persons experiencing houselessness, and to develop skills to provide effective and compassionate care for this vulnerable population.

Objectives: To create a learning environment for students to explore personal assumptions and implicit biases about houselessness; discuss impacts of social determinants of health (SDOH) on people experiencing houselessness; perform decision-making in difficult situations; and collaborate with an interprofessional team.

Methods: Faculty from the schools of nursing, medicine, pharmacy, social work and public health developed and conducted the HSE over two years with the support of subject matter experts. Students assumed the role of a single parent facing challenges related to houselessness in a scripted activity. In Year 1, debriefing sessions focused on uncovering assumptions and implicit biases. In Year 2, debriefing expanded to include discussions about the impacts of SDOH, and an interprofessional teamwork activity regarding potential interventions, including policy initiatives.

Results: Using a retrospective pre-post format, students’ self-assessment on the Interprofessional Collaboration Competency Attainment Survey showed improvements in all 20 questions and 6 domains (all p<0.0001). Students rated the exercise well (mean scores 3.8-4.4 on a 5-point Likert scale). The design and delivery of the simulation was rated highly (4.1-4.5). Student scores indicated improvements in awareness of challenges faced by houseless people related to SDOH, including financial pressures to meet basic needs, challenges in escaping houselessness, emotional stress and frustration, and health outcomes (all p<0.0001).

Conclusion: Results support the HSE as an effective strategy for helping students to uncover personal biases, to identify the impacts of SDOH on people experiencing houselessness, and to gain skills as a working member of an interprofessional team. Desired Impact: Educational experiences building awareness and empathy for houseless persons are essential for the development of a healthcare workforce capable of caring for this vulnerable population.