Caring for the Homeless and Underserved: An Online, Systems-Based, Interprofessional Curriculum (caringwithcompassion.org)

Problem: Many clinicians lack formal training on social determinants of health, public healthcare systems, or special interprofessional care needs of the underserved. Curricular milestones expect graduates to be aware of socioeconomic barriers impacting patient care, but a national curriculum has not been formalized. Locally, learners scored an average of 44% on a baseline needs assessment quiz in these content areas. Further, learners who rotated through underserved clinical venues with a traditional informal curriculum showed no significant increase in knowledge.

Methods: To address these needs, a sharable online curriculum regarding public healthcare systems and biopsychosocial care for the underserved was developed. Interprofessional education and innovative adult learning methods were stressed by forming an interprofessional curriculum design team and incorporating a novel, game-based learning tool. Two curricular domains were identified and divided into case-based learning content modules: Public Healthcare Systems (with modules on epidemiology of the medically uninsured, public health insurance systems, and public healthcare delivery systems) and Biopsychosocial Model of Care (with modules on biomedical needs of the homeless, social determinants of health, the biopsychosocial model of health, and interprofessional team care). The website includes an individualized learner dashboard, case-based didactic modules, extension resources, a trifold case formulation pocket guide, and a milestone-based assessment tool. The core knowledge curriculum is supplemented with a case-based online game that integrates core content into an enjoyable, low-risk learning experience.  The curriculum is in use at numerous institutions nationally, with over 1500 registered users.

Results: Outcome data demonstrates highly significant improvement in examination scores (pretest 45% to posttest 73%, p<0.0001) following exposure to the modules and game for all assessed content areas: epidemiology of populations in need, health care delivery systems knowledge, homelessness and disease, public health insurance, team care, and social determinants. This freely shared online curriculum addresses identified national and local gaps in socioeconomic and sociobehavioral knowledge for clinical learners. Curricular components can be used individually or as a comprehensive curriculum. Given the current healthcare climate, clinicians need to be able to care for traditionally underserved patients. High quality, freely accessible, interprofessional online curricula are resources for both clinical faculty and practicing clinicians.