Attitudes of Medical Trainees Towards Homeless Persons Presenting for Care in the Emergency Department
Condition: Homeless Persons; Emergency Medical Services
MeSH terms: Emergencies
Study type: Interventional

Summary: 
      Homelessness is a significant problem in Canada, and many homeless people will seek routine
      care in the Emergency Department (ED) as a result of barriers to access. There is a paucity
      of information in the literature concerning the attitudes of health care workers towards
      homeless patients in the ED setting, although there is ample reason to believe that these
      attitudes may be suboptimal. In the absence of formal teaching regarding issues of
      homelessness, medical students have been shown to develop increasingly negative attitudes
      towards this vulnerable population. It is therefore important to better delineate the
      attitudes of ED physicians towards homeless persons and to develop an emergency medicine
      curriculum that helps sensitize physicians to the needs of this already disadvantaged
      population.
    

Detailed description: 
      Homelessness increased dramatically in the 1990s and has become a significant problem for
      Canadian cities. The homeless are at increased risk for both traumatic injuries and serious
      health problems. Because of significant barriers to access to care, a large proportion of
      homeless persons will present to the Emergency Department (ED) for acute and routine care.
      When homeless individuals were asked what was the most difficult aspect of being homeless,
      negative reactions by shelter workers and health care providers were included as major
      themes. Despite the recognition that many homeless people are treated in the ED, there is
      little information regarding the attitudes of ED staff and medical trainees towards these
      patients and their care. Furthermore, there are no North American curriculum requirements for
      emergency medicine trainees regarding homelessness or urban health. In the medical setting,
      exposure alone to homeless patients may negatively impact the attitudes of trainees. We
      propose to study the attitudes towards homelessness of medical trainees before and after
      emergency department rotations at an inner city hospital and to define whether implementation
      of a curriculum on homelessness has a positive impact on attitudes.

      This study will be completed over a two year period. During the first year of the study we
      will survey trainees' attitudes before and after clinical emergency department rotations. We
      propose to survey the attitudes of medical trainees using the validated questionnaire, the
      Attitudes Towards Homelessness Inventory (ATHI). A homeless curriculum will be developed
      using feedback from house staff, health care providers, community partners, and agencies. All
      undergraduate and postgraduate students will be eligible to participate. In the second year
      of the study, attitudes will be surveyed before and after completion of the clinical rotation
      and didactic training.

      The primary outcome of interest is to compare the overall ATHI rating of students who are not
      exposed to the curriculum to those who are exposed. Secondary outcome measures include
      comparisons of pre and post rotation scores for each trainee. Subgroups will be analyzed
      according to training program, time of ED rotation, and prior workplace exposure to homeless
      persons.
    

Intervention name(s): Questionnaire
Intervention type(s): Behavioral
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: Single
Keywords: homelessness; Attitudes of medical trainees towards the homeless