Background : Emergency Medicine residents receive very little formal training about social determinants of health (SDOH), including food security, homelessness, and financial strain. When they do receive training, teaching is often confined to traditional didactics. Recent studies show that only 15% of medical students come from low socioeconomic status backgrounds, making it difficult for many to understand the clinical relevance of social factors and the daily complexities of living in poverty.
Purpose/Objective : The purpose of the poverty simulation is to teach learners (new residents in this case) about SDOH through a simulation where they experience the social barriers, limited resources, and accompanying stress that underserved patients face in their daily lives. Through this experience, the goal is to increase learners awareness of how these determinants affect patients’ overall health and serve as a basis of empathy for patients experiencing these challenges.
Methods : Learners were grouped into family units, assigned the role of a family member, and asked to complete tasks of daily living, such working, buying groceries, paying bills, and taking kids to school. Learners were given limited time and resources. These tasks were accomplished at twelve different stations (e.g. bank, daycare, payday loans) that were manned by faculty, senior residents, social workers and representatives from community-based organizations. The simulation was followed by a group debrief.
Outcomes : The simulation provided residents with insight into the daily challenges faced by low-income patients. During the debrief, learners discussed the stress and challenges they experienced juggling various tasks with limited resources, including the difficulty of choosing between housing, utilities, food, and medications and the complexities of public benefits applications. Resident insights were linked back to the challenges faced by patients, the importance of screening for SDOH, and potential roles for healthcare providers in addressing SDOH.