Primary Care Training and Enhancement -- Residency Training in Street Medicine - Persons experiencing homelessness (PEH) have high rates of premature death and a greater prevalence of serious mental illness, substance use disorders, and both acute and chronic diseases, which reflects barriers to accessing health care, housing, and community-based services. Over the last 15 years, North Carolina has exceeded national trends by 50% in its increase of unsheltered PEH. Contemporary residency training curricula are in a developmental phase and need to account for the organizational and structural barriers that PEH face in accessing care, the resources of the community, and the comprehensive care needs of PEH in preparing emerging primary care physicians to provide multi-disciplinary, patient-centered care. The overall purpose of this project is to increase the number of primary care physicians who are prepared to provide care to PEH by developing and enhancing training in street medicine and care of PEH for residents in the University of North Carolina at Chapel Hill Family Medicine Residency Program (UNC FMR). The project will build on an existing curriculum that trains residents in full scope care by leveraging strong partnerships and developing new collaborations with community organizations (i.e., local government and community service agencies) in central North Carolina that will provide a robust interdisciplinary training experience in nontraditional settings for FMR residents in the care of PEH. As a top-ranked family medicine residency training program with an established federally qualified health center track, the UNC FMR has a demonstrated and sustained record of placing graduates in medically underserved communities. The project team is ideally positioned to lead and sustain work with key community partners serving PEH in nontraditional settings in rural, small metropolitan, and urban service areas. The project will develop and implement a new PEH-focused curriculum covering the medical, behavioral, social, and legal needs of PEH, and launch a Comprehensive Care of Homeless Populations Area of Concentration (AOC). The didactic curriculum will provide a foundational knowledge base in the care of PEH, including training in critical time intervention for all residents in the FMR, and an observational experience in street medicine that will be implemented for PGY1 residents. The AOC builds on this groundwork with two months of experiential training outside of traditional health care settings for PGY2s and PGY3s; a one-month small metro/rural rotation in Orange and Lee Counties, and a one-month large metro/urban rotation in Wake County. This training experience will include direct patient care with PEH and interdisciplinary work with community service providers and government agencies that address the social needs of PEH. The project’s progress will be assisted by a community advisory board and will use rapid-cycle quality improvement methods to gather timely feedback regarding the training experience. The project’s evaluation will be inclusive of Health Resource Service Administration-required performance measures and data that will gauge the effect of the training program on PEH outcomes, and the impact of the project on area health care and community service organizations. Project data will be shared locally with community partners and disseminated nationally. This project meets criteria for both funding priority (Rural Training) and funding preference (Qualification 1 High MUC placement rate).
