Can medical students be effectively taught about homeless health using remote large group teaching sessions?

Problem

Patients experiencing homelessness are often encountered by students by chance rather than by purposeful or taught activity. This leads to unequal exposure for students, with the possibility of students avoiding patients, or increasing student stigma to this patient group. Keele University has had an increase in medical student numbers and uses primary care placements across six counties, so allocating clinical placements for all students in these specialist areas is impossible. Previous research into student attitudes towards homeless patients demonstrated that students were anxious about their safety. Dixon et al reported students wanting teaching to prepare them to meet these groups of patients, feeling that opportunities to meet patients with ‘lived experience of exclusion’ would have the biggest impact upon learning. In the UK there has been a shift towards including patients experiencing health inequity in the curriculum, usually as optional activities. To overcome these issues a full-day online teaching session was developed for all fourth-year medical students. This includes the use of prerecorded patient videos to protect this vulnerable population, whilst maintaining a patient centred teaching. This study examines whether it is feasible to teach every student about homeless health, using a digital approach, whilst remaining patient centred. There is paucity of evidence about how effective remote teaching sessions are in teaching these topics.

Approach

The students function as their own control by completing questionnaires before and after the teaching day. This is a questionnaire based upon a validated questionnaire used in US research of medical students’ attitudes towards homeless patients by Feldman et al, modified for use for UK medical students. Further qualitative interviews are planned to look at medium-term implications of this teaching for students that had this teaching session in the previous academic year.

Findings

Interim findings:There have been five teaching days so far in the academic year 2023-24 involving 61 students. 27 students completed both questionnaires.25 students demonstrated a change in their attitudes following the teaching day. The key areas included feeling more confident managing complexity and an increased willingness to work with homeless patients once qualified.

Consequences

So far this study shows that it is possible to use vulnerable patients sensitively in teaching whilst giving a sense of real-patient teaching for the students. It is providing evidence that a remote session can be used effectively to teach large groups of students, negating issues with geography when placements are spread over a wide area.