Primary Care Training and Enhancement -- Residency Training in Street Medicine - The Foundational and Advanced Street Medicine Training Program for Internal Medicine Residents at the University of Washington (“UW Street Medicine Training Program”) will increase the number of graduates in Internal Medicine prepared to care for people experiencing homelessness (PEH). The UW Internal Medicine Residency Program is by far the region’s largest graduate medical education program, with 169 residents total including 39 in the Primary Care Track; historically a large percentage of UW Internal Medicine residents practice general internal medicine after graduation. Homelessness and associated conditions including mental illness and substance use disorders are increasingly common in Seattle and throughout the region; those entering the physician workforce must be prepared to meet the unique needs of PEH. Graduates should understand the implications of social determinants of health (SDoH) for managing health conditions among PEH, how to help patients navigate available support systems, and how to work in interprofessional teams to prevent, diagnose, and manage chronic health conditions associated with homelessness. To accomplish these objectives, the UW Street Medicine Training Program creates two training pathways. First, it creates a Foundational didactic curriculum for all Internal Medicine residents interspersed throughout their three years of training but weighted toward intern year, with instruction in, 1) compassionate engagement and person-centered communication with PEH; 2) diagnosis and treatment of mental health and substance use disorders, including prescribing medications for opioid use disorder; 3) how SDoH impact disease presentations and management strategies for PEH; and 4) how to support patients in navigating the medical, behavioral health, legal, and social support systems available to PEH, including through medical-legal partnerships. Second, this program creates an Advanced Pathway for in-depth training and leadership preparation for Internal Medicine residents particularly interested in careers in homeless healthcare. Up to 4 residents per class will select into the Advanced Pathway during winter quarter of their intern year. Advanced Pathway residents will, 1) complete 2 new electives created by the UW Street Medicine Training Program (described below), 2) complete at least one additional elective rotation in homeless healthcare or addiction medicine, 3) participate in a primary care continuity experience in a community-based outreach clinic serving PEH, and 4) participate in a community, scholarship, and mentorship program designed to create a supported learning community, provide longitudinal mentorship, and support resident scholarship and teaching. Third, the UW Street Medicine Training Program creates two new rotations available to all residents and required of Advanced Pathway residents: 1) “Homelessness: navigating SDoH and legal systems” explores SDoH, community engagement, and medical –legal partnerships, among other topics, and 2) “Interprofessional mobile and street medicine,” provides a variety of clinical community-based experiences in which residents work alongside interprofessional teams to provide medical, behavioral, and substance use care in mobile and other outreach settings. These new rotations, as well as the outreach-based primary care continuity experience, leverage both UW expertise and strong partnerships with community-based organizations. Partner agencies include the largest provider of homeless services in Seattle, one of the largest programs providing medications for opioid use disorder and street outreach in Washington State, and local medical-legal organizations. The UW Street Medicine Training Program requests consideration for a funding priority based on training residents in rural areas.
