Primary Care Training and Enhancement -- Residency Training in Street Medicine - Street Medicine, Impactful Leadership Enhancement in Family Medicine (SMILE-FAM) will design, implement, and evaluate an integrated longitudinal street medicine curriculum in the Henry Ford Hospital Family Medicine Residency Program (HFHFMR) to improve the care for people experiencing homelessness (PEH) while training future street medicine leaders. To prepare our cohorts of first, second, and third-year family medicine residents to provide care for PEH, we will accomplish the following objectives: 1. Develop or enhance trainings, clinical rotations, and didactic and clinical curricula content to train residents in street medicine to provide sensitive and quality care for people experiencing homelessness with attention to mental health and substance use disorders. 2. Increase residents’ knowledge and skills to meet the unique needs of people experiencing homelessness and assist patients with navigation of the medical, behavioral health, legal, and social support systems related to clinical care. 3. Increase residents’ knowledge and skills to work in interprofessional teams, including chronic disease management, mental health, substance use, and medical-legal interprofessional teams, to address the SDoH that impact patient care. Implementation of SMILE-FAM will be guided by both the HFHFMR Street Medicine Curriculum Committee and a Community Advisory Board. We will employ various teaching methodologies, including didactic lectures, monthly group seminar sessions, interprofessional education, self-learning/e-learning platforms, and wellness support. Over the 5-year grant duration all HFHFMR residents (estimated n=64) will complete one-month rotations in providing health care for PEH, including: Intern Orientation; Healthcare Equity Street Medicine; Community-Oriented Primary Care; Senior Street Medicine; Leadership; and Group Leadership and Development rotations. Selected residents will complete a Street Medicine Concentration Track (estimated n=12), which may include participation in a Street Medicine Continuity Clinic, Henry Ford Hospital Street Medicine Consult Service, Street Medicine of Michigan Symposium and other conferences, Street Medicine exchange opportunities, Community Advisory Board, scholarly activity, and a capstone project. The Curriculum Committee will use a mixed qualitative and quantitative approach to evaluate these curricular enhancements and to inform iterative cycles of curriculum improvement. We will track the patient care outcomes by using the electronic health record. There will be focus on patient demographics, reported SDoH including housing status, medical diagnosis, street medicine encounters, ambulatory clinic visits, Emergency Department utilization, hospital admission and 30-day readmission rates. Graduating residents will be followed to assess their practice choices after completing the enhanced street medicine curriculum. SMILE-FAM aims to equip residents with foundational knowledge and skills in street medicine. In addition, we are nurturing attitudes that value wellness, cultural humility, and interprofessional practice—all key ingredients for preventing provider burnout and creating a lasting positive influence on practice choice. This will increase the number of family medicine residents who are prepared to provide quality care for people experiencing homelessness. We request a funding preference for a high rate of placement of graduates in practice settings primarily serving Medically Underserved Communities (MUCs). 53% of HFHFMR graduates practice in MUCs from the 22-23 and 23-24 academic years. Also, HFHFMR has a significant increase, 33%, for the placement of graduates in MUCs between the 22-23 and 23-24 academic years. Our unique exchange with the Munson Health, Traverse City Street Medicine program will create unique learning opportunities for both programs. With the creation of a two-week rural street medicine rotation, we request the funding priority in rural training.
