Primary Care Training and Enhancement -- Residency Training in Street Medicine - The UCSF Family and Community Medicine Residency Program (FCMRP) proposes a Street Medicine Training Program to address the urgent healthcare needs of people experiencing homelessness (PEH) in San Francisco. This initiative responds to the city’s high rates of unsheltered homelessness, substance use disorders, and associated health disparities, which disproportionately impact marginalized populations. Leveraging UCSF’s decades-long commitment to training physicians to serve underserved communities, this program aims to prepare family medicine residents to deliver trauma-informed, patient-centered care tailored to the complex medical and social needs of PEH. The program employs a two-pronged approach: all residents will participate in required street medicine rotations, while those seeking a deeper commitment can opt into a specialized Street Medicine Track for longitudinal training. Residents will rotate through four key clinical sites—Street Outreach Services (SOS), Maria X Martinez (MXM) Clinic, Citywide Case Management, and Team Lily Perinatal Care Clinic—gaining hands-on experience in diverse settings such as street rounds, shelter-based clinics, and transitional care environments. Curriculum development will be guided by a Patient Advisory Council composed of PEH. Training will focus on critical competencies, including substance use disorder treatment (e.g., Medication for Opioid Use Disorder), interprofessional collaboration to address social determinants of health, point-of-care ultrasound (POCUS) in street medicine settings, and management of acute and chronic healthcare issues that frequently arise in PEH. The program emphasizes interprofessional collaboration by training residents to work alongside social workers, case managers, community health workers, and other team members to deliver holistic care. Residents in the Street Medicine Track will engage in longitudinal experiences that deepen their expertise in street medicine practice. These include extended rotations at SOS, MXM, Citywide Case Management, and Team Clinics Clinic and access to higher level curriculum. Evaluation methods will assess resident competence in street medicine skills—including trauma-informed communication, wound care proficiency, POCUS utilization, and systems navigation—and track graduates’ career trajectories to measure their engagement with PEH-focused care. Sustainability strategies include institutionalizing street medicine curricula within UCSF’s residency program structure, securing clinical partnerships beyond the grant period, and diversifying funding sources through philanthropy and value-based care models. UCSF FCMRP is applying for funding preference based on a high percent of graduates working in medically underserved communities (MUCs). 76% of graduates from AY 2022 and AY 2023 are currently practicing in MUCs, demonstrating eligibility for funding preference. Through this initiative, UCSF FCMRP seeks to build a sustainable workforce of family physicians equipped to deliver high-quality care to unhoused populations . By addressing critical training gaps and fostering interprofessional collaboration, this program represents a replicable model for integrating street medicine into family medicine education nationwide.
