University of South Florida

Poverty simulation prepares medical students for patients who struggle

Every physician will have patients who struggle so much with their day-to-day lives that following physicians recommendations, getting prescriptions filled, and even getting to appointments are huge endeavors.

To better prepare future doctors help patients in poverty and identify signs of struggle, the USF Health Morsani College of Medicine offers its medical students a poverty simulation activity, an exercise that allows students to walk a mile in their future patients’ shoes, said Vinita Kiluk, MD, assistant professor of pediatrics, co-course director for Doctoring III section of medical curriculum, and co-director for the primary care clerkship.

“An experience like this will help our students to have more empathy for patients,” Dr. Kiluk said. “We hope that through this simulation, the students will have a better understanding of the barriers faced by patients when having to make decisions between paying bills and filling the prescriptions we prescribe.”

The message of empathy can really make the difference for providing holistic care to patients, said Bryan A. Bognar, MD, MPH, FACP, professor of medicine and vice dean for MCOM Office of Educational Affairs.

“We know that a number of factors beyond medical care combine to affect the health of individuals and communities,” Dr. Bognar said. “Every one of our students will have patients who struggle with poverty, and we know that poverty impacts health in several ways, from an inability to get to resources for help and support to an inability to comply with physician recommendations. This simulation is just one example of how our curriculum provides experiences to help our students become better, more compassionate physicians. By immersing our students into situations that reflect real life, we are offering them an opportunity to have a better understanding of the true reality that many of their future patients face every day.”

The personal, hands-on experience aims to have a lasting impact, said Shirley B. Smith, MA, director of the Office of Student Diversity and Enrichment for MCOM, who initiated the activity at USF MCOM.

“The exercise offers medical students an opportunity to experience what many of their patients – more than they realize – will be going through,” Smith said. “They learn that, as a physician, treating and helping a patient get to optimum health takes more than just what’s within the four walls of a clinic.”

Based on a simulation activity from Central Missouri Community Action, the USF MCOM activity is customized to be more health care centric and has been incorporated into their curriculum, making it required by all students, Smith said. The local American Legion Post donated its community hall to accommodate the large groups of students and volunteers. For the simulation, medical students are grouped into their new “families” and take on those families’ identities, physical ailments, employment statuses and economic situation. The time across a morning is translated into four weeks of experiences in poverty.

“Some are single seniors living alone, some are single parents, some are blended families, some who are recently unemployed, some struggling with disabilties – in essence, it’s about people who are struggling from day to day,” she said.

At the sound of a whistle, these families make their way around the multitude of resources at tables on the periphery, such as banks, groceries and social service agencies, but also pawn brokers and quick cash operators. To get to these places, families must use tickets that represent transportation – which they bought with their allotment of money – but these “errands” can only happen after they take children to school and go to work.

“This exercise, which uses real life scenarios, helps validate patient stories and efforts,” Smith said. “The medical students are provided with only a general sense of their ‘itinerary’ and issues they are facing, causing many to forget they need to pay rent. They also frequently forget to buy groceries.”

COPH sound-icon-png Listen to Shirley Smith, MA, director of the Office of Student Diversity for MCOM, who initiated the project at USF MCOM

Just like real life, there are consequences for forgetting. Not paying rent results in warnings being placed on chairs that represent home. Missing another rent payment results in eviction and the chairs are turned upside down, representing no access to home.

And just like real life, there are unexpected events.

“We have Luck of the Draw cards that one of our volunteers delivers randomly to family members, like losing a job or having the electricity turned off, but also, because of our focus, there are health care issues – suddenly getting ill,” Smith said.

COPH sound-icon-png Listen to David McNeely, a volunteer representing a pawn broker, who has helped with the simulation multiple times.

COPH sound-icon-png Listen to Carol Vanrossen, representing a mortgage and rental agency.

COPH sound-icon-png Listen to Jigar Chauhan, a student playing a disabled person who just got evicted.

The medical students take on these roles with gusto and the scenarios have impact. Second-year medical student Mackenzi Frost is playing a mother with a significant other who is out of a job right now because he has pneumonia, and she has a 1-year-old baby.

“I’m just literally going week to week trying to figure out how to survive,” Frost said “It’s really challenging to get all of the necessities for life covered. We’re all struggling to make ends meet. This project definitely helps make me more empathetic. They say the next best thing to living something is to simulate something, and this helps us feel, at a very small degree, what they are going through.”

The empathy central to this activity carries over to issues of health care.

“The goal of this exercise would be to show us, as medical students, some of the circumstances out of people’s control that contribute to how they approach health care, health spending, and whether they get treatment or don’t get treatment,” said Gilbert Murimwa, a second-year medical student. “It shows how people prioritize their needs. You may not be able to get health care if you have to feed your family or pay for medicine or have an unexpected trip to the emergency room.”

COPH sound-icon-png Listen to MCOM student Gilbert Murimwa. 


COPH sound-icon-png Listen to MCOM student Mackenzi Frost.

The real takeaway is the stress of living day-to-day. One of the biggest struggles for these students, Smith said, is prioritizing. With limited time and resources, when everything they need to accomplish is a must – rent, utilities, food, and juggling all of the agencies associated with those – getting them all done in the allotted time with the allotted money is nearly impossible.

Photos by Sandra C. Roa, USF Health Office of Communications

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