Caring with Compassion supports core background knowledge regarding bio-psychosocial clinical care for homeless, underserved, uninsured, and at-risk populations. This curriculum addresses socioeconomic determinants of health, the U.S. healthcare system as a social determinant of health, and practical approaches to providing clinical care for socioeconomically challenged populations. Modular content provides necessary background information and supports clinical application of that knowledge.
While open to any learner with interest, this content was originally designed for advanced medical students, advanced nursing students, physician interns/residents, nurse practitioners, and physicians seeking continuing medical education. All who complete the didactic material can achieve the identified knowledge objectives.
Core Teaching Content: Case-Based Didactic Modules and Knowledge Evaluation
Two curricular domains are further divided into knowledge modules:
- Domain 1. Public Healthcare Systems includes modules on epidemiology of the homeless and medically uninsured, public health insurance systems, and public healthcare delivery systems.
- Domain 2. Bio-Psychosocial Model of Care includes modules on biomedical needs of the homeless, social determinants of health, the bio-psychosocial model of health, and interprofessional team care.
Each module comprises learning objectives, case-based readings for each objective, and a final module knowledge examination. Each registered learner is provided with an individualized learning dashboard to track his or her progress in each content module. The learning dashboard displays which modules have been completed with a passing score on the post-module knowledge exam. From the dashboard, learners may share their scores with someone, or a supervisor may request shared scores.
Completion of Domain 1 requires 3-5 hours of independent reading: Epidemiology requires 1-2 hours, Public Insurance requires 1.5-2 hours, and Public Health Systems requires 1-2 hours. Completion of Domain 2 requires 4-6 hours of independent reading: Biomedical Conditions Among the Homeless requires 1-2 hours, Social Determinants of Health requires 45-60 minutes, Bio-psychosocial Model of Health and Health Care requires 1-2 hours, and Interdisciplinary Team Care requires 45-60 minutes.
Knowledge Integration: Learning Game
An interactive learning game, Care Consequences, supplements the core content to stimulate knowledge integration. This game presents a common clinical scenario faced by a game character. To earn information regarding their game character’s situation, players engage in fun trivia questions that reinforce the learning objectives. Players must then make a clinical treatment decision. The game character experiences biopsychosocial status changes based on the player’s treatment decision. As players proceed through multiple game levels, they earn points based on the total biopsychosocial state of their game patient, and based on their success in answering the trivia questions. National high scores are openly posted as a player reward.
Clinical Application: Bedside Tools and Clinical Evaluation Tools
A clinical presentation trifold pocket guide supports application of the bio-psychosocial model during clinical care, and a milestone-based clinical evaluation tool supports faculty in providing feedback on directly observed clinical skills.
Supplementary Content: Links and Resources
Selected resource links round out the curricular package.
ACGME Accreditation, Milestones, and Learning Objectives
This content supports graduate medical education institutions in their efforts to advance one of the 6 ACGME Clinical Learning Environment Review focus areas: health care quality, including reduction in health care disparities. A compiled list of module learning objectives is provided. Relevant ACGME milestones are listed on the Milestones page, and the Evaluation Tools page provides a milestone feedback tool: “Evaluation of Progressive Milestones in Team-Based, Bio-Psychosocial Care for At-Risk Populations.”
Practical Implementation Suggestions
We advise assignment of this content during a clinical experience with underserved, uninsured, or homeless patients. The content works well when divided as 1-2 module assignments per week over a 4-week clinical rotation. Modules can be assigned as independent background reading, then reinforced in group discussions. Most training programs find it easiest to assign the core module content as a syllabus then encourage application in clinical settings. For residency programs with learners providing continuity care in Federally Qualified Healthcare Centers, the content has been used for ambulatory case conference discussions. Application during 4th year medical student rotations has also been considered effective, including special attention to the bio-psychosocial history and its effect on patient management options. Faculty are encouraged to personally explore this website, with the following implementation options in mind:
- Online independent study: Modules include formative pre-tests to stimulate learner awareness of their knowledge deficiencies. Case-based reading materials and supplementary resource links are then followed by post-module retesting. The game may be played as many times as one likes, and high scorers are posted to the website. Therefore, this content is designed to support independent, self-directed adult learners.
- Group learning: Following independent pre-reading, content may be reviewed in a group under faculty guidance. Group discussion of the provided learning cases or of actual clinical cases can incorporate the didactic content through formal presentation or informal discussion. Separate conferences are suggested for each module. Four selected modules can be supplemented in this manner in a weekly conference during a standard 4 week clinical rotation. The game can also be used as a fun alternative group conference activity, with faculty commentary on resulting learning opportunities during group game play.
- Knowledge assessment: Educational supervisors may verify learner progress from within their own user account. After logging in, the educational supervisor should select the “Progress and Score Sharing” feature from their Dashboard. Follow the provided directions to request progress reports from a user, or from a list of users. If desired, the supervisor may label user groups to organize their tracked users. Users with confirmed score sharing will be noted. Alternatively, learners may initiate the score sharing by following the same “Progress and Score Sharing” feature from their own Dashboards. In this case, the educational supervisor should inform their learners of the email username with which they should share their scores.
- Clinical implementation. Downloadable tools and Reference Guides for bedside use are provided within the website’s Resources section. Print the trifold Pocket Guide on 8.5x11 paper, printing at actual size; do not “shrink to fit” or the trifold will not fold correctly. Copy single sided printing onto a double-sided single sheet before use. If printing directly as a double-sided document, select “short side” or “top side” binding so that front and back are appropriately oriented. Personalize the trifold by writing in local resources and essential care team members. Use the guide to structure learner presentations and faculty feedback.
- Clinical skills assessment: Evaluation Tools are provided. A Milestone Assessment Tool is adapted from national internal medicine reporting milestones. It may be used as a rotation evaluation that supports application of the Caring with Compassion content.
Limitations and Reflections
Learners have engaged with the curriculum more actively in programs that mandate or actively encourage use. Active endorsement by program leadership is essential for learners to value and engage with the material. Also, we believe that learners must actively apply and reflect upon this knowledge during patient care in order to fully realize the relevance of the learning objectives. Clinical application requires active faculty support and guidance, and may require the support of an interdisciplinary team, including case managers and social workers. Therefore, faculty are strongly encouraged to supplement independent reading assignments with guided case discussion and/or self-reflection exercises, and training programs are encouraged to engage interdisciplinary educators.