Phenomenon: Homelessness is a major public health concern.
Given that homeless individuals have high rates of mortality and morbidity, are
more likely to be users of the healthcare system, and often report unmet health
needs, it is important to examine how homelessness is addressed in medical
education. We wanted to examine content and framing of issues related to
homelessness in the case-based learning (CBL) curriculum and provide insights
about whether medical students are being adequately trained to meet the health
needs of homeless individuals through CBL.
APPROACH:
CBL
content at a Canadian medical school that featured content related to
homelessness was analyzed. Data were extracted from cases for the following
variables: curriculum unit (e.g., professionalism/ethics curriculum or
biomedical/clinical curriculum), patient characteristics (e.g., age, sex), and
medical and social conditions. A thematic analysis was performed on cases
related to homelessness. Discrepancies in analysis were resolved by consensus.
FINDINGS:
Homelessness
was mentioned in five (2.6%) of 191 CBL cases in the medical curriculum. Homelessness
was significantly more likely to be featured in professionalism/ethics cases
than in biomedical/clinical cases (p = .03). Homeless patients were portrayed
as socially disadvantaged individuals, and medical learners were prompted to
discuss ethical issues related to homeless patients in cases. However, homeless
individuals were largely voiceless in cases. Homelessness was associated with
serious physical and mental health concerns, but students were rarely prompted
to address these concerns.
The health and social needs of homeless
individuals are often overlooked in CBL cases in the medical curriculum.
Moreover, stereotypes of homelessness may be reinforced through medical
training. There are opportunities for growth in addressing the needs of
homeless individuals through medical education
- 1 Faculty of Medicine, Dalhousie University , Halifax , Nova Scotia , Canada.
- 2 Department of Medicine , University of Toronto , Toronto , Ontario , Canada.
- Teach Learn Med. 2016 Jan-Mar;28(1):35-40. doi: 10.1080/10401334.2015.1108198.
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