Poverty Simulation: A Novel Application for Pediatric Education

Background: Pediatricians frequently provide care for families struggling with health issues related to poverty, but may have little personal experience with poverty. Poverty simulation has been used to educate individuals in other disciplines about how poverty impacts daily life. Little is known about the impact of poverty simulation on pediatric residents’ attitudes toward poverty. Objective: To determine whether exposure to a poverty simulation improves pediatric resident physicians’ attitudes toward poverty. Methods: Pediatric interns in a single program voluntarily participated in an evaluation of a poverty simulation conducted during intern orientation. Anonymous surveys were IRB-approved and consisted of the Attitudes Toward Poverty - Short Form (ATP-SF), which was administered immediately before and after the intervention, and a satisfaction survey administered after the intervention. Cronbach’s alpha was utilized to determine the internal reliability of ATP-SF sub-scales. Differences in the pre and post-simulation ATP-SF surveys were assessed with t-tests. Results: 84% of pediatric interns completed both the pre- and post-ATP-SF. Internal consistency for the Personal Deficiency (7 items) and Stigma (8 items) subscales was excellent (Cronbach’s alpha of 0.908 and 0.906, respectively, combined across assessments). A third subscale, Structural Perspective (6 items), had an acceptable Cronbach’s alpha of 0.623. The Stigma and Structural Perspective sub-scales trended toward significance with higher post-intervention scores (p=0.114 and 0.131, respectively). There were no significant differences between responses on the ATP-SF. 100% of pediatric interns completed the satisfaction survey. 100% of pediatric interns agreed that they would recommend the simulation to a colleague and that their professional work would improve as a result of participating in the simulation. Conclusion: There were no statistically significant differences between responses to the ATP-SF pre and post intervention. However, all respondents endorsed that the poverty simulation would positively impact their professional work and would recommend the simulation to a colleague. Further study is needed to characterize the impact of poverty simulation on residents’ attitudes and clinical practice. There is also potential for the simulation to be studied as a faculty development tool.