Primary Care Training and Enhancement -- Residency Training in Street Medicine - Project and Needs to be Addressed: Family Health Centers of San Diego (FHCSD) is applying for HRSA-25-078, Primary Care Training and Enhancement-Residency Training in Street Medicine (PCTE-RTSM). FHCSD plans to enhance street medicine (SM) training for FHCSD’s ACGME-accredited Family Medicine Residency Program (FMRP) residents. We will implement precision education standards to enhance our training approach and our didactic and clinical curricula content specific to street-based care - so that residents are able to bring sensitive, quality healthcare and psychosocial support directly to their patients experiencing homelessness, reaching them where they are at, where they are most comfortable, and regardless of their ability to pay. We plan to create a new paradigm for training activities at FHCSD that will enhance all aspects of leaning, teaching, and patient care in the SM setting. A cross-organizational, multi-disciplinary curriculum development team will redesign the current 2-week SM elective into a 2+-month competency-based curriculum, rotation, professional development, and robust evaluation methodology. The re-designed and expanded rotation will provide personalized and continuous learning, assessment, and feedback for trainees, their faculty, their training coaches, and a broad swath of preceptors from across multiple SM roles. PEH in San Diego face significant barriers to the most basic of services, and their situations typically complicate the care they are able to receive. This program will triple the number of FMRP residents each year who obtain competency and empathy as they learn to understand and treat the complex health challenges faced by PEH, and will drive expansion of the SM program into new venues and additional service hours. Proposed services: Access to resident experiential training and training venues for this program will be provided in conjunction with the SM Team and at a number of SM venues across San Diego, including through street rounds; in encampments, homeless shelters, and safe sleeping program lots; alongside our syringe services program and mobile Medication Assisted Treatment units; and anywhere PEH in need are found outside of traditional clinic sites. The multi-disciplinary curriculum team will develop the expanded program utilizing precision education models, learning contracts, rubric-based assessments and evaluations, professional development in positive coaching and precepting, and an emphasis on competency-based, experiential, field-based learning. Training content will address medical care for acute and chronic conditions, co-morbidities, substance use disorders and cutting-edge treatment, mental health concerns including psychiatry, behavioral health needs, interprofessional teamwork, medico/legal issues, and an in-depth understanding of the many social determinants of health (such as social isolation) that impact care for this patient population. Population groups to serve: In the past year, FHCSD served over 166,000 patients annually, including over 28,000 people experiencing homelessness (PEH), both sheltered and unsheltered. The target population is primarily unsheltered, those who prefer to be seen outside of the standard clinic setting. Whether unsheltered or unstably housed, they will be seen across San Diego but primarily in field-based venues in the Central, East, and South San Diego regions. They will receive care regardless of their ability to pay. Venues will be clustered in communities historically and currently negatively impacted by and at highest risk for homelessness. Local needs assessments show they are a highly vulnerable group, lacking safety, security, privacy, and support networks and with significant health and psychosocial concerns.
