Primary Care Training and Enhancement -- Residency Training in Street Medicine - Street Medicine Addition to Resident Training (SMART) will train Family Medicine residents at Wright State University’s Boonshoft School of Medicine (BSOM) and Kettering Health to deliver trauma-informed, interdisciplinary care to individuals experiencing homelessness and extreme poverty in both urban Dayton Montgomery County and rural Miami County, Ohio. This program aims to equip residents with the skills to provide high-quality healthcare in non-traditional mobile settings, collaborate with community partners, and address structural barriers that hinder care access and care outcomes. Modifications will occur to existing residency clinical rotations and the enhancement of didactic training leveraging local expertise and community resources. Residents will complete structured, community-based clinical experiences in street medicine, including a mobile health unit stationed at the Dayton Dream Center (urban) and the Bethany Center (rural) providing primary care, behavioral health support, and harm reduction services. Residents will also complete “backpack medicine” rounds in collaboration with the Dayton Fire Department’s Get Recovery Options Working (GROW) Team, offering care directly to encampments and individuals recently treated for overdose. The residency curriculum will also be updated to include a 3-year series of sessions on trauma-informed care and harm reduction, infectious disease management in street medicine, substance use disorder treatment, and the impact of Social Determinants of Health (SDoH) and legal barriers on patient care. The three primary WSU objectives of this project are: Workforce Development: Produce the next generation of local primary care physicians with expertise in street medicine by training at least 90 Family Medicine residents by the end of the grant in June 2030, through evidence-based, trauma-informed street medicine rotations, ensuring cultural and linguistic competency. Family Medicine Resident Physician Education Enrichment: Enhance didactic and experiential education to train residents to address the unique needs of persons experiencing homelessness and extreme poverty in both urban and rural settings by integrating the knowledge and skills of specific chronic disease management, substance use, and behavioral health topics into street medicine-focused residency training. Immersive Systems-Based Practice: Increase residents’ knowledge of SDoH and the skills to navigate social systems through intentional interprofessional team-based care and local community partnership with community servic The SMART program will be led by an experienced primary care physician specializing in underserved populations and senior leader in medical education, along with faculty from Family Medicine, Population and Public Health Sciences, Psychiatry, and Addiction Medicine. The program is supported by an interdisciplinary team of clinicians, social workers, peer recovery specialists, and legal experts, many already collaborating on the newly formed Dayton Street Medicine program, funded with OneOhio opioid settlement start-up funds. Funding will support the inclusion of Family Medicine physician resident training and expanded care days and locations, specifically adding a rural location. Montgomery and Miami Counties have high rates of homelessness and SUD. In 2023, over 5,000 individuals experienced homelessness in Montgomery County, with the region ranking among the highest in Ohio for opioid overdoses and illicit drug use. SMART is designed to prepare residents to address these urgent public health needs and improve access to care for Ohio’s most vulnerable populations, particularly in Primary Care and Mental Health Professional Shortage Areas (HPSAs). A funding preference is requested, as 66.6% of AY 22-23 and 23-24 family medicine graduates practice in primary care medically underserved communities following residency. A funding priority is also requested as we have a Family Medicine rural program.
