University of South Florida

Poverty simulation allows students to walk a mile in a limited income person’s shoes

For the first time, the exercise brings together students from all USF Health colleges.


Living in the moment is a way of life that countless people strive to achieve, but for those living in poverty, the concept takes on a much more somber meaning. If someone is struggling to make ends meet, their daily life is so stressful that they’re probably not thinking about or planning for the long term.

Every day, health care professionals come face-to-face with patients in poverty and in order to teach students empathy and an understanding of these barriers, USF Health Morsani College of Medicine Office of Student Diversity and Enrichment hosts poverty simulations. This training is in its sixth year, but this year is the first with an interprofessional mix of athletic training, medical, nursing, public health, pharmacy, physician assistant, and physical therapy students, as well as residents, and fellows. At the end of 10 sessions provided in the 2018-19 academic year, about 840 people will have participated.

The local American Legion Post donated its community hall to accommodate the large groups of students and volunteers.


Based on a simulation activity from Central Missouri Community Action, participants have the opportunity to experience life in the shoes of a fixed, limited-income family.

Shirley B. Smith, MA, Director of the Office of Student Diversity and Enrichment for MCOM, begins the activity by instructing the group to take it seriously because, “these are real people who have lived this experience.”

The students were assigned to fill various family roles, with identities ranging from seniors living alone to single-parents and blended families. Each family struggles with barriers such as unemployment, disabilities, and transportation. Over the course of a simulated four weeks, the families’ priorities are shelter, electricity, food, and keeping the family together.

The assigned identities range from single seniors living alone to single parents and blended families. Some are recently unemployed or struggling with disabilities.


A variety of resources are offered to the families by volunteers stationed around the community center room.  The volunteers simulate the roles of bankers, grocery store clerks, hospital staff, social service workers, and a pawn broker. Over the course of the activity, participants may run out of time or money, or even just forget to pay rent or buy groceries. One family was visited by law enforcement after she forgot to pick up her child from day care. Another family pawned their furniture for extra money. At least three families were evicted.

“This experience gives insight to health care workers, because sometimes we don’t know what is going on in a patient’s life and how it’s affecting their treatment or compliance,” said Brolivia Harvey, an adjunct faculty member in the College of Nursing.

Volunteers staff the resource tables that represent businesses such as banks, groceries, social service agencies, pawn brokers, and quick cash operators.


Participants without private transportation have to budget for public transportation passes needed to get to each resource station.


Just like in real life, when the rent is not paid, families are evicted.


At the end of the interprofessional education simulation, the participants sit down for a debrief. More than half of the students raised their hands when asked if they felt stressed or anxious during the experience. One student shared that she felt a “sense of insecurity” the entire experience and how you don’t realize the mental health strain it’s having on you or your children.

“I think the poverty simulation made everyone more aware of the struggles that people go through. We saw how much had to be accomplished in one day and that someone living in poverty may have to choose to pay rent instead of buy their medication,” said Rumour Piepenbrink, a first-year public health student.

“It was an eye-opening and humbling experience. I felt an array of emotions from frustration to gratitude for what I have,” said Ashley Reed, a fourth-year nursing student.

First-year public health student Rumour Piepenbrink visits the payday advance quick cash station.


Fourth-year nursing student Ashley Reed speaks with the volunteers at the simulated hospital.


During debrief, the group discussed how they can apply the lessons they learned from the poverty simulation to their health care careers:

  • Don’t judge your patients.
  • You have to consider the situation your patient is coming from to best help them.
  • Be aware of local resources to refer a patient in need.
  • Besides providing a resource to help a patient right now, empower them for the future.
  • Teach patients the importance of long-term health.
  • Physician burnout can happen when you do not deal with not being able to help everyone.

“Don’t ever get to the point where you’re numb to the poverty or problems of the people in the community,” said Priscilla Perez, a case manager for Positive Spin, a community-based social service agency that assists children and families to live healthy, and long-time poverty simulation community partner. “Helping a patient is more than just taking care of the reason for their visit,” she added.

Students are not the only ones participating in the poverty simulation. A session in April will include USF Health leadership and faculty.

“At USF Health, we are committed to preparing health professionals who recognize the importance of interprofessional team-based care, not only in the clinical setting but also in working together to address the social determinants of health in the communities we serve. Engaging our faculty in this intensive training will help us be better teachers and encourage us to recognize and emphasize the important role that every member of the team plays, including our patients and our community partners,” said Donna Petersen, ScD, senior associate vice president of USF Health and dean of the College of Public Health.

USF Health students, residents, and fellows debrief after the poverty simulation.


-Multimedia story by Torie Doll.

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