Assessing medical students' knowledge, confidence, and skills in caring and advocating for undocumented immigrant patients [Meeting Abstract]
BACKGROUND: Patients who are immigrants, notably those with undocumented status, face challenges to equitable healthcare access. By understanding immigration status as a social determinant of health (SDOH), physicians can begin to address such disparities. However, few undergraduate medical curricula include formal longitudinal instruction addressing immigration. We conducted a needs assessment of a medical school's curricular content in teaching medical students to address immigration as a SDOH.
METHOD(S): MS1-3 students from a school in Bronx, NY where 35% of the patient population are immigrants, received a 13-question email survey via surveymonkey.com. Students were assessed on three primary areas based on a literature review on sanctuary doctoring and SDOH: 1) Knowledge of immigrants' barriers to care (4-point scale, strongly disagree to strongly agree); 2) Confidence in assessing patient immigration status, taking an immigration history, and advocating for patients at risk of deportation (3-point scale, not confident to very confident); and 3) Frequency of assessing patients' immigration status, identifying immigration status when presenting cases, and referring undocumented patients to social/legal resources (4-point scale, never to always). Outcomes were compared between pre-clinical (MS1-2) and clinical (MS3) students.
RESULT(S): Among 539 students, 159 (29.5%) responded, with 104 preclinical and 55 clinical students. 79.2% strongly agreed that undocumented immigration status limits healthcare access. Few students reported being very confident in asking about immigration status (8.8%), taking an immigration history (12.6%), providing legal information (2.5%) and advocating for patients at risk of deportation (6.3%). Compared to the pre-clinical cohort, clinical students were significantly more confident in taking an immigration history (p=0.04) but not in other skills. Few students endorsed frequently or always asking patients about immigration status (3.2%), identifying immigration status when presenting patients (4.5%), and referring undocumented patients to appropriate resources (8.3%). There were no significant differences in frequencies of use of clinical skills pertaining to care of immigrant patients in the pre- and clinical cohorts.
CONCLUSION(S): Students are aware of barriers that immigrant patients face but lack confidence and experience in identifying and supporting undocumented patients. Our results will inform a revision of the longitudinal curriculum, including didactics and practical activities. LEARNING OBJECTIVE #1: 1. Assess students' skills and confidence in identifying and advocating for undocumented immigrant patients in clinical practice LEARNING OBJECTIVE #2: 2. Assess students' knowledge of immigrants' barriers to care