Medical Students, Residents Reach Out to Help the Homeless

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Students from the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences are treating patients where they live—in this case, the streets and shelters for the homeless. Twice each week, students and faculty arrive at Buffalo’s downtown bus station equipped with basic medical supplies, hats, and gloves. The team members are part of UB HEALS (Homeless health, Education, Awareness, and Leadership in Street medicine), a service learning program that provides medical care and clothing to homeless people.

Monday, August 21, 2017

Engaging Medical Students in Treating the Homeless

Student-run clinics for homeless patients provide care to vulnerable people as well as important hands-on experience for learners. Programs include clinics that operate only on one day at one site as well as those that operate more frequently and in multiple locations. Some examples:

  • HOMES (Houston Outreach Medicine, Education, and Social Services) is a joint collaboration of the Baylor College of Medicine, University of Texas Health Science Center, and University of Houston College of Pharmacy. Open on Sundays to provide medical care to homeless people instead of them needing to use emergency rooms, HOMES is the city’s only student-managed clinic. It has oversight from attending physicians and from Healthcare for the Homeless–Houston.
     
  • Students at the David Geffen School of Medicine at UCLA can participate in student-run homeless health clinics in various locations, including Santa Monica and West Los Angeles, and may receive degree credit for their involvement. Clinics are supervised by UCLA faculty.
     
  • Hawaii H.O.M.E. (Homeless Outreach and Medical Education) Project of the John A. Burns School of Medicine offers student-run clinics on Oahu. Four clinics are run each week, at seven sites, staffed by students and University of Hawaii residents and faculty. Hawaii has the highest per capita rate of homelessness among all states.
The effort gives students “an opportunity to realize that very close to the urban areas they’re used to is a whole different life,” said David A. Milling, MD, senior associate dean for student and academic affairs, and faculty advisor to the program. In mild weather, the students and physicians conduct rounds on the streets; during Buffalo’s bitter winters, they see patients in three homeless shelters. Although the scope of care is limited, UB HEALS connects interested people to other medical help.


Students receive training in understanding the varied needs of the homeless population, Milling said. In reflection sessions, they talk and write about what they’ve learned. Since March 2016, about 150 students have participated in the program, which was first suggested by a student.

Getting a clearer picture of patients’ lives

Students from Boston University School of Medicine (BUSM) interview and listen to homeless patients in a clinic and respite unit run by Boston Health Care for the Homeless Program (BHCHP). At the group’s facility located at Boston Medical Center (BMC), the students practice physical exam skills, work with a supervising physician, and learn about issues and conditions seen more in homeless people, such as hepatitis C.

“In medical school, we are taught to focus on treatment of the medical problems patients present with. But as a provider, you have to find out what is driving disease instability to break the cycle,” said Thea James, MD, vice president of mission and associate chief medical officer at BMC. “When a person doesn’t have secure housing ... [that] becomes a driver of health instability.”

As part of her BUSM curriculum, third-year student Stephanie Lie recalls watching a man have his history taken in the hospital. One month later, she interviewed the same man in the BHCHP clinic, where greater privacy, more time, and use of supportive language helped him open up more. “The clearer picture about his current medical problems was really awesome,” she said.

“When a person doesn’t have secure housing ... [that] becomes a driver of health instability.”

Thea James, MD
Boston Medical Center

Monday, August 21, 2017

Learn Serve Lead 2017: The AAMC Annual Meeting

Learn Serve Lead 2017: The AAMC Annual Meeting, Nov. 3-7 in Boston, will feature several opportunities for exploring academic medicine's role in reducing health disparities.

Through the project, Nicholas Chiu, also a BUSM third-year student, became interested in the movement to establish safe injection facilities for anyone with opioid addictions. “When you learn about the systemic problems, you get a perspective and want to do something about it,” said Chiu. The student authored a resolution to the Massachusetts Medical Society (MMS) to study the feasibility of a pilot facility for safe injections in the state and to develop a society stance. The study was completed in 2016 and MMS now supports the concept. Although his effort to help people with opioid addictions went beyond the homeless population, “The whole process stemmed from going to the homeless health clinic, seeing the problems patients face, and having them tell you about it,” he said.


Residents at Boston area hospitals often rotate through BHCHP’s shelter clinics, too. For trainees, “it can be life altering,” said Joan Quinlan, MPA, vice president for community health at Massachusetts General Hospital. “For academic medical centers, it’s a fabulous training opportunity” to offer “community-based, real-world experiences.”

Read the first article in the series on how several teaching hospitals in Boston have collaborated to establish a clinical program to treat homeless people.

During Learn Service Lead 2017: The AAMC Annual Meeting, BHCHP has agreed to open its doors to 30 attendees on Friday, Nov. 3. To schedule a visit, please email Catherine Minahan at cminahan@bhchp.org with your preferred tour time: 2, 2:30 or 3 p.m. We also are asking members of the academic medicine community to consider making a donation to BHCHP in advance or at the meeting.