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Introduction: Poverty is generally defined on a fiscal metric despite the fact that it disrupts every facet of a patient’s life. The United Nations (UN) recently published its campaign focused on Ending Poverty. In this publication, the UN describes poverty as “entailing more than the lack of income and productive resources to ensure sustainable livelihoods.” The manifestations include hunger, safe housing, transportation, education, and social discrimination. To fully appreciate the effects of conditions such as poverty requires a deeper understanding of the complex social environment that impoverished individuals are forced to navigate. Poverty simulations are one practice to provide a more personal experience to facilitate development of social empathy.

Objective: Utilizing an online poverty program designed by a team at Case Western Reserve University, the goal of this study was to determine the effect of this simulation on student empathy development towards individuals living in poverty. A secondary aim of this study was to foster interprofessional (IP) collaboration in the setting of addressing healthcare disparities.

Methods: Assessing changes in empathy as accomplished by administering the student versions of the Jefferson Scale of Empathy. This is a validated, 20-item tool that assesses for attitudes and beliefs on the use of empathy in a clinical setting. The primary author, along with members of the team at CWRU that developed the simulation, created an additional questionnaire that promoted IP team-thinking in addressing healthcare disparities. Participants were volunteers from different health-professional colleges at Thomas Jefferson University. Pre- and post-simulation empathy scales were administered. Statistical analysis on the results included paired-type T-tests. The additional questionnaire was administered after the post-simulation empathy scale and the responses were collected to determine overarching themes or gaps in knowledge.

Results: The average pre-simulation empathy scale was 119 out of a maximum 140. Six participants showed significant changes in their pre and post-empathy scale scores (p = 0.024). Fifteen participants showed no changes in their pre and post-empathy scale scores. The results from the additional questionnaire show that students most identify social workers, physicians, and nurses as primary members of a team to address healthcare disparities. Further, more students selected a greater number of healthcare professionals to be a part of a team to address healthcare disparities than to address poverty. When asked to provide an action the participants could take as future providers, the most common response was to screen for disparities and provide resources.

Conclusions: The empathy scale measures healthcare professional student beliefs on the utility and impact of empathy in a clinical setting. The CWRU poverty simulation was created to both change the perception of individuals living in poverty and expose participants to the challenging environments impoverished individuals are forced to navigate. Therefore, it may not have as great an effect on changing the participants’ underlying beliefs of the role or importance of empathy in a healthcare setting. Future studies should utilize other tools to assess for knowledge gained from the simulation. The results from the additional questionnaire show a discordant understanding of the importance and role different healthcare professionals play in addressing patient disparities. Further education on IP team-collaboration is warranted.



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