Primary Care Training and Enhancement -- Residency Training in Street Medicine - The overall goal of the Johns Hopkins Primary Care Urban Health Combined Internal Medicine-Pediatrics Residency (PCUHR) is to strengthen the role of primary care and improve the health of our community. Our program’s mission is to “develop a community of primary care physician leaders who partner with patients to improve intergenerational health in Baltimore and beyond. Our urban health curriculum pairs comprehensive clinical training with community-based learning, readying our residents to build a society in which all can flourish.” This grant will allow us to produce leaders in primary care with particular expertise in street medicine. The Baltimore City 2024 Point-in-Time Count (PIT) found 1,487 homeless individuals on a single night in January 2024. Of those counted, 67% were men, 16% were chronically homeless, 9% were veterans, and 18% were youth. Of adults who were sleeping in emergency shelters, 37% had a serious mental illness, 14% had a substance use disorder, 4% were living with HIV/AIDS, and 4% were survivors of domestic violence. In 2023, 1,551 individuals were identified as homeless and 113 were counted as rough sleepers. Cities like Baltimore contend with well-known health problems that are magnified in the rough sleeper population. Chronic disease, SUDs, poverty, behavioral issues, psychiatric illness, and numerous health, and social issues plague the city. Lack of access to primary care physicians who are knowledgeable about special needs of our community, especially for patients living on the street, exacerbates all of these health issues. HRSA aims to improve access to quality health care for all, especially unhoused patients, by improving the preparation and distribution of the PCP workforce. Our objectives perfectly align with this goal. To accomplish this goal, we will develop greater than 2 months of street medicine rotation experiences, add street medicine didactics to urban health noon conference, and create a medical-legal partnership (MLP). The street medicine rotations will include a PGY1 two-week urban community medicine rotation that features CBOs who serve the homeless. A two-week PGY2 rotation at Health Care for the Homeless (HCH) will follow and include time on the HCH van. As a PGY3, residents will work with HCH preceptors to provide year-long longitudinal care to Baltimore’s rough sleeper community. As a PGY4, residents will spend 1 week providing care in the Neighborhood Nursing program that targets the geriatric community with unstable housing living in the Johnston Square Community. The MLP will be a collaboration between the UHPCR and the University of Baltimore School of Law’s Saul Ewing Civil Advocacy Clinic. We will provide a 1-month rotation in addiction medicine and a 2-week rotation in psychiatry/behavioral and mental health. We will support interprofessional teamwork by funding Hopkins Community Connection (HCC), paraprofessionals who help patients navigate the different systems and resources which can improve their lives. Additionally, we will provide residents with simulated experiences to help them provide TIC and address ACEs in our community. The PCUHR has a track record of producing a dedicated primary care workforce. To help our residents grow their QI skills, we will add a Director of QI who will teach QI principles and mentor residents completing QI projects in the continuity clinic. Over 90% of our graduates practice primary care, and most practice in MUCs. To further those results, we will add a coaching program that will provide for additional primary care mentorship and feedback on clinical skills. We will also continue our rural relationship with Tuba City Regional Health Services. We are applying for a funding preference for high MUC placement rate and a funding priority for rural training.
