Primary Care Training and Enhancement -- Residency Training in Street Medicine - More than 161,000 individuals in California experienced homelessness in 2024, the highest number in the nation. 74% are peopled experiencing unsheltered homelessness (PEUH), living outside of the shelter system - under bridges, in cars, and along riverbanks. The epicenter of California’s crisis is in its most populated county, Los Angeles, which hosts 42% of California’s and nearly 20% of the nation’s unsheltered population. PEUH suffer higher rates of trimorbid conditions (i.e. the combination of physical, mental health and substance use disorder diagnoses) which further erode day-to-day stability and exacerbate already steep hurdles to engaging in the standard healthcare model. USC Street Medicine, established in 2018, provides comprehensive primary care, substance use treatment, and mental health care five days a week to patients on the streets of Los Angeles through an interprofessional team. In addition to a robust street based clinical arm, USC Street Medicine has a long history of building capacity through workforce development/education of family medicine residents and other medical learners while integrating research and the impact of policy on health. USC Street Medicine has partnered with Keck School of Medicine Family Medicine Residency and Ventura County Medical Center Family Medicine Residency to develop the Primary care for UnsheLtered homeless in Street Medicine Education (PULSE) Program. The goal is the PULSE Program is the increase the number of physicians trained in a primary care specialty who are prepared to provide care for people experiencing homelessness, by brining care to people outside traditional clinical settings. The PULSE Program will achieve its aim through five innovative learning interventions: a Street Medicine Boot Camp, Street Medicine Didactic Education, Street Medicine Podcast with open office hours, and Clinical Rotations with rotation specific curriculum and Beyond Ordinary Opportunities Supporting Training (BOOST) activities. Residents will complete two required one-month rotation with USC Street Medicine and have an optional 2-week focused street medicine rotation at USC or a different street medicine program either in or outside of California. Using a structured competency-based street medicine educational framework, the PULSE Program will combine a longitudinal didactic curriculum with robust clinical experiences to equip these residents with the necessary foundation to meet American Board of Family Medicine Core Outcomes. Internationally recognized experts in Street Medicine will contribute to didactic and podcast material, and residents will work closely with the street medicine providers, including Addiction Medicine Specialists and Street Psychiatry, to gain a nuanced understanding of adapting clinical medicine to treat complex chronic illness, substance use disorders, and mental health conditions in the dynamic environment of the street. A robust evaluation plan, including a quality improvement committee and a PULSE Program Advisory Board composed of community-based organizations, resident and faculty street medicine champions, people with previous lived experience in homelessness and those currently experiencing homelessness, will help evaluate and iterate the program throughout the during the grant. A well-rounded dissemination will promote manuscript submission for peer reviewed journals and conference presentations. We anticipate training 50 family medicine residents who will earn a Street Medicine Certificate for completing all requirements of the PULSE program. 54 additional residents and core faculty will be exposed to the didactic curriculum. We are applying with funding preference, as 86.2% of VCMC FMRP graduates from 2022-23 and 2023-24 classes are practicing in medically underserved communities.
