Page 14 - Christiana Care Focus August 2018

Residency Program |
Poverty simulation helps doctors in training understand the lives of people they serve
Each summer, a highlight of orientation week for Christiana Care’s new medical residents is an innovative training that asks young doctors to imagine what it is like for their low-income patients when time and money are stretched to the breaking point. And for residents, the experience is often eye-opening.
“I found this to be very worthwhile,” said Stephen Doyle, M.D., a first-year resident in emergency medicine. “The more experience you can have putting yourself in someone else shoes, the greater your empathy and the more you are able to appreciate the obstacles that patients face.”
On June 21, about 90 residents took part in a Community Action Poverty Simulation, as an imaginary city was created inside the John H. Ammon Medical Education Center. There was a food market where only Spanish was spoken, a pay-day loan company, a transportation system, a school, a workplace, a health network, a police department and other services staffed by individuals from the greater Wilmington area playing the roles they actually perform in their real jobs in the community. One of the goals of the simulation is to give residents an awareness of community
Tdynamics as well as resources available to patients.
he young doctors stepped into the responsibilities of a poor mother, father or child trying to make ends meet during 15-minute simulation segments representing a week in their lives. During a month of seeking to survive
despite scarce resources, the stress on the residents intensified as they began to feel the tightening grip of compromises that individuals who live close to the poverty line make every day.
First-year psychiatry resident Sana Sharma, M.D., portrayed a nine- year-old taking care of her seven-year-old brother with a learning disorder. With her mother incarcerated, and the whereabouts of her father unknown, Dr. Sharma, her brother and grandparents were surviving on her grandfather’s $500 disability check. And it wasn’t enough.
“I wanted to help out my family, and I was surprised, because I am normally a very law-abiding person, but my first instinct was to do whatever I had to do,” she said. “So I robbed my neighbors. I took anything I could get my hands on.”
For Dr. Sharma, the simulation was a valuable experience, in that she found health care to be a lesser priority as day-to-day survival became her focus. “These are things you don’t normally think about, and I hope to remember this,” she said. The simulation gave
First-year residents crowd around a “banking officer” played by David Paul, M.D.
her a new understanding of why patients might have difficulty
making it to appointments and why they are unable to pay for Cmedications.
hristiana Care provides a clinical learning environment for more than 280 residents within various programs. For the last three years, the poverty simulation has been an important immersion experience during orientation
week to sensitize new residents to the issue of health equity
and the everyday realities of Delawareans who struggle with
low income and live in impoverished neighborhoods, said Dana Beckton, director, Diversity and Inclusion. “This is a good way for the residents to have an early sense of where some of their poorest patients are coming from and the concerns they bring into the health care setting,” she said. “It is an awakening for many of these young people.”
Each year the poverty simulation has been co-led by Beckton and Jacqueline Ortiz, MPhil, director, Health Equity and Cultural Competence. They say that physicians in training are well-posi- tioned to establish a new culture of medicine with an appreciation for diversity, disparities in care and social determinants of health. But for teaching hospitals, there has been no standardized method for training residents on these issues, and there have only been limited opportunities for busy residents to interact with local communities.
“The more experience you can have putting yourself in someone else shoes, the greater your empathy and the more you are able to appreciate the obstacles that patients face,” said Ortiz.
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