Primary Care Training and Enhancement -- Residency Training in Street Medicine - Dignity Health Sierra Nevada Memorial Hospital (SNMH) seeks multi-year funding to support the development and expansion of Street Medicine in four primary care residency programs in Northern California: our new, rural primary care residency program in collaboration with three other Dignity Health primary care residency programs in Northern California. The Sierra Nevada Family Medicine Residency program in Grass Valley, California is a collaboration with SNMH and Chapa De Indian Health Centers, a Federally Qualified Health Clinic and tribal entity. The sponsoring institution is our urban partner, Dignity Health Methodist Hospital of Sacramento. Located in the Sierra Foothills of Northern California approximately an hour and a half from Sacramento, the Sierra Nevada Family Medicine Residency program will graduate its first class of residents in 2026. Sierra Nevada is the only hospital in a service area that is home to 100,000 residents in western Nevada County, a part of north Placer, and very remote towns in Sierra, and Yuba counties. The partners in this Street Medicine program include the GME programs at SNMH, Dominican Hospital in Santa Cruz California, Mercy Medical Center in Merced California, and St. Joseph's Medical Center in Stockton California. This unique collaboration will pair a rural program that has a tribal continuity clinic with more urban underserved programs that are all part of the Dignity Health/CommonSpirt Health System to create a multi-disciplinary robust curriculum that can be shared across the system of GME programs. An important distinction in this program, in addition to our multi-site collaboration, is the current pilot curriculum at the St. Joseph’s Medical Center in Stockton. This site has started to test an informal, two-week street medicine rotation as part of the month-long community service rotation. The findings and learning from this work puts our program in the forefront of development and evaluation. We can stage the new programs and expansion based on real-time findings to build a more effective curriculum for all. The goal of the program is to increase the number of physicians trained in a primary care specialty who are prepared to provide care for people experiencing homelessness, by bringing care to people outside of traditional clinical settings. The ultimate measurable outcome over the five year grant period will be 128 residents, rural and urban, trained in Street Medicine during their PGY2 and PGY3 years of residency. The program is appropriately positioned to address multiple priorities of the proposal with a focus on chronic diseases, social determinants of health, and behavioral health. Strong partnerships with our local County agencies and nonprofit agencies paired with mobile clinics and vans will ensure we can develop the appropriate curriculum and serve the unhoused comprehensively. The main objectives to reach our program goal are: Develop or enhance trainings, clinical rotations, and didactic and clinical curricula content to train residents in street medicine to provide sensitive and quality care for people experiencing homelessness with attention to mental health and substance use disorders; Increase residents’ knowledge and skills to meet the unique needs of people experiencing homelessness and assist patients with navigation of the medical, behavioral health, legal, and social support systems related to clinical care; Increase residents’ knowledge and skills to work in interprofessional teams, including chronic disease management, mental health, substance use, and medical-legal interprofessional teams, to address the SDoH that impact patient Care; Ensure evaluation, feedback, sustainability and promotion is an essential part of the program development.
