Short Simulation Can Change Pharmacy Students' Attitudes About Poverty

Simulation exercises can positively alter pharmacy students’ attitudes toward poverty.

A study recently published in The American Journal of Pharmaceutical Education evaluated the impact of a 3-hour Community Action Poverty Simulation on second-year pharmacy students at North Dakota State University (NDSU). The stimulation measured the pharmacy students’ changing attitudes toward poverty and subsequent cultural sensitivity.

Pharmacy schools around the country value awareness of varying sociodemographics as an important facet of their curriculum. Colleges have been in search of effective means of improving student knowledge, attitudes, and behaviors, particularly in the area of social stigma. This simulation has the potential to improve student attitudes toward poverty in the pharmacy community.

Poverty is a key social determinant of health that significantly impacts access to continual quality care. In fact, the most frequently cited reason (71.7%) for patients not obtaining necessary medication is being unable to afford it. The goal of the stimulation is to recognize the range of social determinants of health in order to diminish such inequities and increase access to quality care.

During the simulation, students were organized into family units and assigned different scenarios. Each family unit was presented with a specific set of circumstances that mimicked a month of living with limited resources.

Participants assumed roles ranging from single elderly persons to multi-generational homes. Together, they collaborated on how to feed their families, budget expenses, and respond to common challenges faced by that particular control group for a 1-month period.

The month was broken up into 4 weekly segments, each 15 minutes in duration. Participants were given a role to either go to work, school, or daycare and encountered circumstances that could impact their ability to meet their family’s personal and financial responsibilities.

Luck-of-the-draw cards subjected each family to circumstances that may or may not improve their situation. Good luck may provide unexpected funds, such as a cash birthday present, while bad luck may bring an illness, eviction, or criminal activity, resulting in jail time and loss of income.

Students who attended the simulation were surprised how hard it was to navigate the precarious health care system with such limited resources.

“Trying to do this for one hour was so stressful; I can’t imagine living it day-to-day,” stated second-year student pharmacist Sarah Rumbellow. “It will help change my expectations of my patients living that way and the lack of information they might have about resources available.”


Understanding how poverty impacts access to quality health care is an important component of pharmacy education. The simulation ultimately helped the students gain insight into some of the disparity in the provision of medical services that their future patients may face, as well as some ways to guide and assist individuals with varying demographics and financial wherewithal.

“In role-playing, [the students] did things they normally wouldn’t do to survive,” said Elizabeth Skoy, associate professor of practice at the NDSU School of Pharmacy, in a press release. “They learned that it’s really easy to cast judgment, and as health care professionals, to think about what could be affecting someone’s well-being and think outside of what’s immediately visible.”

The exercise successfully and positively altered pharmacy students’ attitudes toward poverty and heightened their overall cultural diversity awareness.