Lessons in Poverty: An Innovative Learning Workshop for Residents Open Access

To learn about health equity and implement the principles of fostering health equity into practice, residents must first learn about the communities they serve. As such, the Virginia Commonwealth University (VCU) internal medicine longitudinal health equity curriculum includes instruction in the social determinants of health that impact VCU’s patient populations—including poverty. Like many academic health centers, our health system is located in a city with a high proportion of residents living in poverty (23%) and below the federal poverty line (12%).¹  When teaching about social determinants of health, an interactive and engaging learning model that challenges learners to question their own biases and critically think about these issues is vital. We initially utilized a poverty simulation, but while some residents found the experience to be valuable, others gave feedback about the problematic nature of a simulation. This activity gamifies people’s everyday experiences and may create an othering for any residents who have experienced poverty in their lives. With this feedback, we recognized that this simulation was not adhering to one of medicine’s basic principles: First do no harm. With research, we developed a different model to achieve this goal.

Using the Learning for Justice²  lesson plan as a guide, we developed the Lessons in Poverty Workshop with interactive scenarios. In advance of the session, we sent residents learning objectives and suggested prereading. VCU’s Chief of Health Impact presented an introduction to define terms and educate the residents about demographics of the patients served by VCU. Residents were put into small groups with program leadership and core faculty serving as facilitators. The small groups worked through 2 lessons for 2 hours: “What is Poverty,” in which they defined poverty using the federal poverty level and calculated the minimum cost of living locally, and “The Cycle of Poverty,” in which they discussed factors contributing to poverty and compared short- and long-term poverty. The workshop concluded with a keynote address by the director of a local community center.

We successfully ran the Lessons in Poverty workshop in January 2022 and 2023 with 10 small groups comprised of 5 to 6 interns and 1 or 2 facilitators. We conducted the workshop at a local community center in a historically redlined community. Out of 52 respondents from the 2023 workshop, 45 residents (87%) felt the workshop increased their empathy toward those facing poverty. Over 70% of residents felt the workshop changed their own biases toward poverty and rated the workshop as very good or excellent (38 and 37, respectively [n=52]; Figure). Comments included “we feel as though we understand what people go through until we have to listen and hear details about it” and “after half a year of residency where these issues take a mental backseat to the demands of residency, it is a refresher and a reminder that these issues are prevalent.” Critical feedback included wanting to have more information about resources for those facing poverty. The workshop on poverty is not specific to the field of internal medicine and is pertinent to any physician caring for patients.

The workshop is built in a way that it can be used yearly with minimal changes. The costs included donations to the community center and breakfast provided. This engaging learning model offers an interactive and innovative way for residents to not only learn about social determinants of health but also relate them to the way they care for patients.