Primary Care Training and Enhancement -- Residency Training in Street Medicine - Many consider homelessness to be specific to urban settings. However, the number of unhoused people in central and rural Missouri is increasing. The University of Missouri Family Medicine residency program offers training in both urban and rural communities. Our goal is to increase the number of family physicians who provide street medicine for persons experiencing homelessness. We will employ the following objectives to meet this goal: Objective 1: Create didactic and clinical curricula in street medicine that teach the unique medical knowledge and skills needed to care for the unhoused population in rural and urban settings. Objective 2: Increase residents’ abilities to assess and navigate social determinants of health utilizing interprofessional teamwork. Objective 3: Enhance residents’ knowledge of mental health conditions and substance use disorders. Objective 4: Increase residents' abilities to address homelessness and healthcare needs in rural areas. Currently, our resident physicians have inadequate training in the care of people without secure housing. We lack curricula regarding social determinants of health.? Our residents report feeling unprepared to care for individuals with mental health or substance use disorders who lack access to healthcare resources. Our program uniquely trains resident physicians in rural communities that surround our primary urban training site. The medical and mental health resources for persons experiencing homelessness in these communities are lacking. Our project will address each of these gaps in training and care. Our street medicine curriculum will include didactic and clinical components, and the faculty development necessary to execute the curriculum. We will create a longitudinal street medicine seminar series to be incorporated into our existing weekly half-day resident seminars. We will emphasize the care of underserved patients in low resource settings and a deeper understanding of the social determinants of health. Our clinical rotations will focus on proficiency in mental health care and substance use disorders. Our program will partner with Phoenix House, a local organization that provides substance use disorder treatment for many unhoused patients. We will also create a substance use disorder clinic through University of Missouri Health Care and incorporate resident learners. To increase resident engagement in the community, we will meet with community partners to better understand gaps in care and opportunities for residency training. Residents will work with MedZou, a student-run free clinic, to expand outreach efforts. Residents will work with CoMo Mobile Aid Collective, an organization that offers semi-weekly mobile health clinics and provides medical services to members of our community living in encampments. The street medicine rotations will promote residents as part of interprofessional teams including nursing students, community case workers, and University of Missouri law students to advocate for unhoused persons across a variety of domains. We will develop relationships with community resources in rural neighboring counties, which will expose our residents to the care of unhoused people in rural settings with access to fewer resources. This curriculum will also allow residents to tailor their learning experience based on interests and training location. This may include additional experiences in wound care, dental emergencies, legal aid, harm reduction, rural mobile clinics, and rural health system navigation. The two-month curriculum balances clinical, behavioral, and legal training, ensuring that residents are well-prepared to address the complex, multifaceted challenges facing homeless populations in both urban and rural settings. Our project will serve the growing number of unhoused persons in rural and urban mid-Missouri. We are requesting the Rural Training Priority and the High MUC placement rate funding priority.
