Patient Care Programs

Caring with Compassion - Training Providers to Better Serve Socioeconomically Disadvantaged Patients

(Left to right) Pamela Davis, MD; Brent William, MD, MPH; Davoren Chick, MD; April Bigelow, PhD, ANP-BC; Heather Rye, LMSW, CCM

Despite providers’ increasingly important role and genuine interest in caring for vulnerable populations, many health care professionals lack formal training regarding social determinants of health, public health care systems or special care needs of the medically underserved. Even though national accreditation standards include expectations that clinicians reflect awareness of socioeconomic barriers impacting patient care, there is currently no formalized national curriculum. An interprofessional team made up of physicians, nurses, social workers and medical educators at U-M decided to address this issue head on. They identified both a strong local and national need for a curriculum that supports learners who provide medical care for high risk, socioeconomically disadvantaged patients, with an emphasis on the needs of homeless, uninsured and under-insured patients.

“We were finding that many learners were feeling unprepared to help these populations. You can’t just drop someone into a homeless clinic and expect them to figure it out. There are special skill sets that need to be learned”, explains Davoren Chick, MD, FACP, an associate professor from the Division of General Medicine who regularly provides care at a homeless shelter clinic. “They need a cognitive framework to work from in order to engage in productive care of these populations. At the same time, we were hearing from faculty that they didn’t feel they had the proper knowledge or resources to teach those skills.”

Creating the Curriculum

Supported by a Graduate Medical Education Innovation grant from the University of Michigan Medical School, the team developed a modular,

interdisciplinary curriculum that would support clinical learners and faculty in assessing and formulating a biopsychosocial approach for socioeconomically disadvantaged patients with complex care needs. They identified specific knowledge objectives across seven inter-related content areas:

  1. demographics of the medically uninsured and homelessness in the United States
  2. public health insurance programs, with emphasis on Medicare and Medicaid
  3. national public health care delivery systems
  4. social determinants of health, with an emphasis on socioeconomic status
  5. biomedical care needs of homeless and at-risk patients
  6. the biopsychosocial model of care, with emphasis on special psychosocial considerations for underserved and low socioeconomic status populations
  7. team-based inter-professional care for high risk populations.

Independent learning modules were created for each of the content areas. They provide case-based, clinically relevant, concise and politically neutral content exploring each identified learning objective. The modules have since been formally peer-reviewed and published through the AAMC MedEdPORTAL, with two subsequent major revisions to ensure continued clinical relevance and include current evidence.

Taking It Online

Dr. Chick then collaborated with Michigan Creative, a group at U-M that provides professional design and website development services, to explore the best ways to present these core learning modules online. The result was the Caring with Compassion website — caringwithcompassion.org — that includes a complete set of curricular tools to support diverse learner needs, including:

  • Formal instructor’s guide
  • Informal learner’s guide
  • An individualized learner dashboard supporting each user in tracking progress
  • A downloadable version of the core learning content (“The CaringBook”)
  • Extension links and resources
  • A clinical case pocket presentation guide that reinforces learning points during clinical care
  • A milestone-based skill assessment tool to support formative feedback and skill application
  • Professionally produced videos simulating real life perspectives that reinforce clinical objectives

The site is open to the public and the aggregated curriculum is designed to be engaging, flexible, portable, responsive to handheld devices and appropriate for diverse health professionals at multiple stages of training.