How Can Poverty Impact Healthcare? Med Students Get a Glimpse

Aug 18, 2016

Waiting in line at a soup kitchen or riding a bus may not be typical medical school curriculum, but that's exactly what some med students did last week.

More than 20 medical students from the University of Colorado School of Medicine gather in the kitchen of the RJ Montgomery homeless shelter on Sierra Madre.

Over 20 medical students gathered in the RJ Montgomery shelter kitchen to begin the PICOS exercise.
Credit Holly Pretsky / KRCC

They're weary after spending the night sleeping on the floor at Springs Rescue Mission, another agency in town. They haven't showered.

They gather in small groups to look over their assignments for the day.

Tyler Reinking, Alicia Paredes, and Dr. Heather Cassidy are one group. They're assigned the scenario of Amanda.

"Amanda" is 19 years old. She can't go home because of abuse, and she thinks she's four months pregnant. She doesn't have a phone or a car. She has $10.62 in her pocket. She's unemployed and sleeping in an abandoned building with her 17-year-old boyfriend.

Reinking and Paredes are both students at the CU School of Medicine. Dr. Cassidy is set to join the faculty of the Colorado Springs branch, housed at UCCS.

Amanda's scenario, like all the others in the exercise, is based on real cases meant to highlight challenges often faced by lower income residents in need of healthcare. The situational experience can help provide perspective to the medical students.  

The group has a few objectives for the day for Amanda, including finding medical care and confirming she's pregnant, securing a place to stay for the night, and beginning to look for a job.

They learn they can't stay the night at RJ Montgomery because it's a sober shelter, and, according to the scenario, Group Amanda smoked marijuana in the last 24 hours. They have to find somewhere else.

Dr. Erik Wallace directs the Colorado Springs branch of the CU Medical School, and organizes the Poverty Immersion Colorado Springs exercise, or PICOS.

"It's to give people an idea of what it's like to live in poverty, how people struggle," he says. "How difficult it is to find resources, how difficult it is to eat healthy and be healthy when you have limited resources."

Participant Dr. Heather Cassidy says what might be the most ideal treatment isn't always realistic.

"Amanda" is 19 years old. She can't go home because of abuse, and she thinks she's four months pregnant. She doesn't have a phone or a car. She has $10.62 in her pocket.

"I could create you the perfect plan for your diabetes," says Cassidy. "But if you can't follow through on it because of the circumstances related to your finances, or your living arrangement, or your access to the plan I've made, it might as well be nothing, right?"

On the first day of the two-day experience, students listened to presentations from El Paso County Public Health, Pikes Peak United Way, and others.

Throughout the exercise, Group Amanda grappled with difficult questions. They had to figure out where to go, how to get there, and how to pay for it.

Participant Alicia Paredes says now that she's completed the exercise, she realizes how important it is not to make assumptions.

"Always remembering and trying to make a connection, like a real human connection instead of jumping to conclusions, which I think is something that's really easy for us to do," says Paredes. "That's a huge thing that I'm going to take away from this."

Cassidy will be joining the Colorado Springs branch faculty as Director for Community Engagement. She says she plans to reach out to the partnering agencies she encountered during the exercise to continue incorporating their work into the medical school curriculum.

"We need to sit down with them and figure out where their needs are," she says. "And then how we might be able to bring some creative energy and manpower in the body of enthusiastic medical students who can come into that space and help build something."

This is the second annual PICOS exercise. After participant feedback last year, organizer Dr. Erik Wallace replaced a formal dinner with the night spent sleeping at the Springs Rescue Mission.