Abstract
Objective
The purpose of the study was to explore changes in medical students ’ attitudes toward homeless persons during the Psychiatry and Emergency Medicine clerkships. Simultaneously, this study explored attitudes toward homeless persons held by Psychiatry and Emergency Medicine residents and faculty in an attempt to uncover the “hidden curriculum” in medical education, in which values are communicated from teacher to student outside of the formal instruction.
Methods
A group of 79 students on Psychiatry and 66 on Emergency Medicine clerkships were surveyed at the beginning and end of their rotation regarding their attitudes toward homeless persons by use of the Health Professionals’ Attitudes Toward the Homeless Inventory (HPATHI). The HPATHI was also administered to 31 Psychiatry residents and faculty and 41 Emergency Medicine residents and faculty one time during the course of this study.
Results
For Psychiatry clerks, t -tests showed significant differences pre- and post-clerkship experiences on 2 of the 23 items on the HPATHI. No statistically significant differences were noted for the Emergency Medicine students. An analysis of variance revealed statistically significant differences on 7 out of the 23 survey questions for residents and faculty in Psychiatry, as compared with those in Emergency Medicine.
Conclusion
Results suggest that medical students showed small differences in their attitudes toward homeless people following clerkships in Psychiatry but not in Emergency Medicine. Regarding resident and faculty results, significant differences between specialties were noted, with Psychiatry residents and faculty exhibiting more favorable attitudes toward homeless persons than residents and faculty in Emergency Medicine. Given that medical student competencies should be addressing the broader social issues of homelessness, medical schools need to first understand the attitudes of medical students to such issues, and then develop curricula to overcome inaccurate or stigmatizing beliefs.
Similar content being viewed by others
References
Plumb JD: Homelessness: care, prevention and public policy. Ann Intern Med 1997; 126:973–975
Hwang SW: Homelessness and health. CMAJ 2001; 164:229–233
Schanzer B, Dominguez B, Shrout PE, et al: Homelessness, health status, and health care use. Am J Public Health 2007; 97:464–469
D’Amore J, Hung O, Chiang W, et al: The epidemiology of the homeless population and its impact on an urban emergency department. Acad Emerg Med 2001; 8:1051–1055
Lester HE, Bradley CP: Barriers to primary health care for homeless people: the general-practitioner perspective. Eur J Gen Pract 2001; 7:6–12
Association of American Medical Colleges: CurrMIT (Curriculum Management and Information Tool). [Online]. Available from: http://www.aamc.org/meded/curric/ [Accessed 26th October 2009]
McQuistion HL, Ranz JM, Gillig PM: A survey of American psychiatric residency programs concerning education in homelessness. Acad Psychiatry 2004; 28:116–121
Masson N, Lester H: The attitudes of medical students towards homeless people: does medical school make a difference? Med Educ 2003; 37:869–872
Wear D, Kuczewski MG: Perspective: medical students’ perceptions of the poor: what impact can medical education have? Acad Med 2008; 83:639–645
Buchanan D, Rohr L, Kehoe L, et al: Changing attitudes toward homeless people. J Gen Intern Med 2004; 19:566–568
Hafferty FW, Franks R: The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med 1994; 69: 861–871
Ozolins I, Hall H, Peterson R: The student voice: recognising the hidden and informal curriculum in medicine. Med Teach 2008; 30:606–611
Wear D, Skillicorn J: Hidden in plain sight: the formal, informal, and hidden curricula of a psychiatry clerkship. Acad Med 2009; 84:451–458
Morrison A, Roman B: Experience at a homeless clinic in a psychiatric clerkship. Poster presentation at ADMSEP. Galveston, TX. June 2008
Buck DS, Monteiro FM, Kneuper S, et al: Design and validation of the Health Professionals’ Attitudes Toward the Homeless Inventory (HPATHI). BMC Med Educ 2005; 5:2
Newton BW, Barber L, Clardy J, et al: Is there hardening of the heart during medical school? Acad Med 2008; 83:244–249
Tompsett CJ, Toro PA, Guzicki M, et al: Homelessness in the United States: assessing changes in prevalence and public opinion, 1993–2001. Am J Community Psychol 2006; 37:47–61
Wen CK, Hudak PL, Hwang SW: Homeless people’s perceptions of welcomeness and unwelcomeness in healthcare encounters. J Gen Intern Med 2007; 22:1011–1017
dela Cruz FA, Brehm C, Harris J: Transformation in family nurse practitioner students’ attitudes toward homeless individuals after participation in a homeless outreach clinic. J Am Acad Nurse Pract 2004; 16:547–554
Chung-Park M, Hatton D, Robinson L, et al: RN-to-MSN students’ attitudes toward women experiencing homelessness: a focus-group study. J Nurs Educ 2006; 45:317–322
Hunt R: Service-learning: an eye-opening experience that provokes emotion and challenges stereotypes. J Nurs Educ 2007; 46:277–281
Brown JD, Bone L, Gillis L, et al: Service learning to impact homelessness: the result of academic and community collaboration. Public Health Rep 2006; 121:343–348
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Morrison, A., Roman, B. & Borges, N. Psychiatry and Emergency Medicine: Medical Student and Physician Attitudes Toward Homeless Persons. Acad Psychiatry 36, 211–215 (2012). https://doi.org/10.1176/appi.ap.10080112
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1176/appi.ap.10080112