A first-year medical student had an unusual class assignment. He pretended to be a 13-year-old girl begging a pawn shop owner for a few dollars to help feed hungry siblings.
The unorthodox exercise was part of a poverty simulation that more than 200 Joe R. and Teresa Lozano Long School of Medicine students participated in to learn empathy for patients living in poverty.
“The experience overall was a positive one because, with all the changing circumstances and the difficulties that would pop up within our lives as a family, there were experiences of frustration and difficulty,” said Alex Kelly, a student who was part of a family of four in the simulation. “For example, we were robbed, and we lost all the money we had and I did feel like this weight, like ‘I don’t know what we’re going to do now.'”
As part of the annual exercise, students take on a persona like the head of a family of four trying to survive on slightly more than $27,000 a year, an elderly person living alone on Social Security or someone living in a homeless shelter. Individually and in groups, the students visited 17 stations set up as social services and businesses scattered around the room, attempting to navigate the everyday challenges faced by those in poverty.
During four 15-minute intervals, students tried to get to work on time, take children to school and pay their monthly bills, while the number of their transportation vouchers dwindled along with other resources. Collin Pelton, a member of Kelly’s “family” said the robbery was especially impactful.
“A lot of people think, ‘Oh if you just budget correctly, you’ll be able to afford everything,’ and it’s like you don’t see the unplanned stuff,” Pelton said. “That’s the thing that gets people the most is that, sure, you can budget all you want, but if you are living paycheck to paycheck, it’s hard to budget for the random unfortunate events that are going to happen.”
A Missouri nonprofit created the simulation. It was first used in the UT Health San Antonio School of Nursing, said Melanie Stone, MPH, MEd, assistant director of community service learning at the university’s Center for Medical Humanities and Ethics. A few years ago, Jason Morrow, MD, PhD and Sylvia Botros-Brey, MD, MSCI, associate professors at the School of Medicine, incorporated the activity into their required course for medical students, a curriculum that focuses on empathic communication, professionalism, and social determinants of health.
With one-third of the nation living at or below the poverty line and more than 17% of San Antonio’s population meeting the federal definition, Stone said the simulation gives the students context before they begin to meet patients.
It’s essential that students participate in the simulation at the beginning of their career, Morrow said. He facilitates the simulation with Ruth Berggren, MD, MACP, director of the center.
“We like meeting students early in their journey. The sooner they can feel comfortable with ambiguity and with stressful experiences people bring to the clinical environment, the sooner they will be prepared working with patients,” Morrow said.
At the end of the simulation, many students said they were frustrated and felt a loss of control over their finances. Stone said the exercise is the best way for students to empathize with patients who have financial struggles. This should be an experience that stays with students, Stone said.
“The idea is that it’s long term. These are going to be health care professionals who are going to be much more community-minded, community-oriented and are going to build professional identities that are service-oriented,” she said.