Attitudes of Medical Trainees Towards Homeless Persons Presenting for Care in the Emergency Department

Emergency Medical Services Clinical Trial

Official title:

Attitudes of Medical Trainees Towards Homeless Persons Presenting for Care in the Emergency Department

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00281398
• Other study ID #: 05-31
• Status: Completed
• Phase: N/A
• First received: January 18, 2006
• Last updated: June 19, 2013
• Start date: August 2005
• Est. completion date: December 2007

Study information

• Verified date: June 2008
• Source: St. Michael's Hospital, Toronto
• Contact: n/a
• Is FDA regulated: No
• Health authority: Canada: Health Canada
• Study type: Interventional

Clinical Trial 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.

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 100
• Est. completion date: December 2007
• Est. primary completion date: December 2007
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Both
• Age group: 25 Years to 45 Years

Eligibility

Inclusion Criteria:

• 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.

Study Design

Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Single Blind

Related Conditions & MeSH terms

• Emergencies
• Emergency Medical Services
• Homeless Persons

Intervention

Behavioral:
• Questionnaire

Locations

Country	Name	City	State
Canada	St. Michael's Hospital	Toronto	Ontario

Sponsors (2)

Lead Sponsor	Collaborator
St. Michael's Hospital, Toronto	The P.S.I. Foundation

Country where clinical trial is conducted

Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The main outcome measure is the difference in change in the mean score in those who have participated in the curriculum compared with those who have not during the 2nd year of the study.
Primary	Objective 1: To describe the attitudes of medical trainees towards the homeless population before and after completion of an emergency medicine rotation at St. Michael's Hospital
Primary	Objective 2: To define, develop, and implement a core curriculum in care of the homeless patient for emergency medicine rotations in Canada
Primary	Objective 3: To determine the effect of curriculum implementation on the attitudes of trainees towards homeless patients in the Emergency Department