Palliative Care in the Inner City Elective

Integrating Social Accountability and Clinical Care for Marginalized Populations

Background

This elective was developed with the goal of integrating clinical palliative care of structurally vulnerable populations with social accountability. Structurally vulnerable populations suffer from harm through their interface with socioeconomic, political and cultural/normative hierarchies. This includes people who experience poverty, homelessness, racism, colonialism, ableism, criminalization, etc.
In this elective, learners will gain a better understanding of the barriers faced by structurally vulnerable populations in the palliative care context, and how to work towards achieving equity in palliative care provision at micro, meso and macro levels. This will be accomplished through clinical experiences providing outreach visits with PEACH physicians, health navigators and coordinators, as well as interprofessional staff (health and social services). 
Clinical experiences will also be complemented by the completion of a “Social Accountability Workbook” to deepen the learner’s knowledge of concepts and themes introduced through the rotation including trauma informed care, harm reduction, etc.
Rotations must be for a minimum of 3 weeks in duration. This elective is available to medical students, residents and fellows.

Learning Objectives

Medical Student:
  1. To enhance understanding of a palliative approach to care and the principles of advanced care planning.
  2. To become familiar with basic approaches to symptom management in the palliative care setting.
  3. To explore shared models of care and the importance of collaboration and building capacity with inner city providers when caring for a marginalized population.
  4. To be able to describe the barriers that exist to providing effective palliative and end-of-life care for structurally vulnerable populations.
  5. To enhance understanding of social accountability and of the skills required to advocate for marginalized patients on micro, meso and macro levels.
  6. To practice trauma-informed, culturally safe care with a focus on harm reduction in the palliative care setting.
Resident:
  1. To enhance skills in facilitating goals of care conversations and describing a palliative approach to care.
  2. To enhance skills in providing effective pain and symptom management.
  3. To explore shared models of care and the importance of collaboration and building capacity with inner city providers when caring for a marginalized population.
  4. To be able to describe the barriers that exist to providing effective palliative and end-of-life care for structurally vulnerable populations.
  5. To enhance understanding of social accountability and of the skills required to advocate for marginalized patients on micro, meso and macro levels.
  6. To practice trauma-informed, culturally safe care with a focus on harm reduction in the palliative care setting.
Palliative Care Resident/Fellow:
  1. To be able to describe the barriers that exist to providing effective palliative and end-of-life care for structurally vulnerable populations.
  2. To become skilled in providing palliative care in the inner city community while collaborating with, and enhancing the capacity of, inner city workers.
  3. To gain an appreciation for the value, rewards and challenges of providing hospice care for marginalized populations.
  4. To enhance understanding of social accountability and of the skills require to advocate for patients on micro, meso and macro levels.
  5. To practice trauma-informed, culturally safe care with a focus on harm reduction in the palliative care setting.

Elective Structure

You will work with the mobile PEACH (Palliative Education & Care for the Homeless) team.
  • PEACH is a supportive palliative service fostered by Inner City Health Associates (ICHA), Kensington Health and Home and Community Care Support Services. Aimed to meet the needs of people experiencing homelessness or vulnerable-housing with life-limiting illnesses, PEACH’s focus lies with the pain, symptoms and psychosocial goals related to each and every patient’s life’s end. PEACH operates as a “trailblazing” mobile unit, providing attentive care on the streets, in shelters, and with community-based service.
Rotations must be for a minimum of 3 weeks in duration. This elective is available to medical students, residents and fellows.
*We will be fielding scheduling inquiries primarily for academic year 2024-2025. Please contact Dr. Deborah Pink () and Trudy Stedford-Sinclair () for scheduling availability and waitlist.