Primary Care Training and Enhancement -- Residency Training in Street Medicine - Munson Medical Center proposes the Rural Street Medicine Residency Expansion Project under the HRSA Primary Care Training and Enhancement—Residency Training in Street Medicine (PCTE-RTSM) Program to strengthen physician training in non-traditional healthcare settings. The program’s objective is to increase the number of family medicine physicians equipped to care for individuals experiencing homelessness by integrating clinical experiences that bring healthcare directly to underserved populations. To achieve this, Munson Medical Center will implement a structured training model that expands, enhances, and formalizes Street Medicine education within its accredited residency program. This initiative will serve six rural counties in Northern Michigan—Antrim, Crawford, Grand Traverse, Kalkaska, Otsego, and Wexford—all designated as rural areas by the Federal Office of Rural Health Policy (FORHP). These regions face significant healthcare workforce shortages, limited behavioral health resources, and social determinants of health (SDoH) barriers that hinder access to consistent medical care. Through the Rural Street Medicine Residency Expansion Project, primary care residents will gain hands-on training in mobile medical units (MMUs), shelter-based clinics, encampment outreach, and interdisciplinary team-based care, preparing them to work effectively in rural and medically underserved communities. The project will enhance resident education by incorporating core competencies in primary care, behavioral health, addiction medicine, and medical-legal advocacy. Training in these diverse settings will provide future physicians with practical experience in managing complex health conditions, addressing social determinants of health, and delivering trauma-informed care. By focusing on interdisciplinary collaboration, the program will connect residents with mental health professionals, addiction specialists, social workers, and legal advocates to ensure a holistic approach to patient care. Building upon the success of TC Street Medicine, which has already demonstrated significant improvements in patient outcomes and a 76% reduction in emergency department (ED) utilization, this expansion will further increase the number of residency graduates trained to care for people experiencing homelessness. Five core activities will be implemented during the project period: 1. Development of a standardized curriculum with a specialized area of concentration in Street Medicine. 2. Establishment of required clinical rotations, ensuring every resident gains direct experience in outreach-based care. 3. Implementation of a Rural-Urban Exchange Program, partnering with an urban-based program to expose residents to different models of care. 4. Opportunities for mentorship and professional development, including participation in research. 5. Creation of a “grow your own” workforce development model, focusing on physician retention strategies in medically underserved rural communities. Through this expansion, the Rural Street Medicine Residency Program will create a sustainable training model that aligns with federal and state efforts to reduce ED overutilization, improve chronic disease management, and expand healthcare access for individuals experiencing homelessness. By equipping residents with critical skills in outreach-based, interdisciplinary, and trauma-informed care, this initiative will ensure that future physicians are well-prepared to serve vulnerable populations in both rural and urban settings. This proposal seeks consideration for the rural priority designation in alignment with the criteria established by the HRSA Primary Care Training and Enhancement—Residency Training in Street Medicine (PCTE-RTSM) program. Additionally, this rural training program qualifies for the second funding preference, as it has demonstrated a 33.3% increase in residency graduates securing positions in medically underserved areas in previous academic years.
