Pretend you are bus-bound and have no access to other means of transportation. You need to get to an appointment on the other side of town. Take the bus and observe the ridership, wait times, and overall duration of the trip.


- Students will reflect on how structural determinants such as public transportation may influence access to, and usage of, health services

- Students will observe the populations that ride the bus and interpret their possible health care needs


Varies, depending upon the bus route chosen. (For the purpose of our class, we'll be starting and ending at the Kentucky Clinic and taking the #3 and #5 lines to get to a location near Tates Creek Road)

Recommended Preparatory Reading:

Paula Braverman and Laura Gottlieb, "The Social Determinants of Health: It's Time to Consider the Causes of the Causes" Public Health Reports 129, Supp 2 (2014), 19-31.

Time Commitment: 

Varies, depending on the transit system. Budget half a day to be on the safe side.

Appropriate For: 

advanced undergraduate students; undergraduate medical students; graduate students in the health professions.

Activity Description:

1. Form a group of 2-3 students; you will accompany each other on the ride. In preparation for the ride, you will want to be sure you remove all jewelry, do not bring valuables, and do not wear clothing that is likely to draw attention to you. Wear warm clothes and good walking shoes. You may want to pack a snack. You may bring a cell phone but keep it tucked away and turned off. Bring your student ID and $20 to call a cab to return you to campus in case of an emergency (you can reach the cab at 859-231-8294; or, you can call Uber if you have a smartphone and the app). With your group, choose a time and day that you plan to make your "appointment."

2. Your student ID should get you free ridership on the bus system. Get on the #5 line (Nicholasville) in front of the Kentucky Clinic and ask for a transfer. When you get to the transit center, get off the bus and transfer to the #3 line (Tates Creek). Get off at Stop F (Tate's Creek and Appian Way) and walk to your "appointment."

While on the bus, try your best to blend in with the other bus riders. No cell phone usage, no laptops, no chatting about medical school adventures, no note-taking, no "interviews" of other bus riders.

3. When you reach your location, take a picture of all of you in front of the office door.

4. Your  mission is halfway complete! Now, you just have to get back to campus. Take the #3 and #5 lines back to the Kentucky Clinic.

5. When you return to campus, write up your field notes describing:

- What biases or preconceptions did you have going into the activity? 

- Who is riding the bus? Does anyone on the bus seem to have medical needs?

- What would it be like if you had to get a child or elderly parent to your appointment on time using only the bus services?

- What was the mood of the bus that day?

- What would it be like if you were sick?

- What skills do you have to have to get around on the bus?

- How might this experience help you to better understand your patients (and, of course, treat them better)? Take into account the biases and preconceptions you identified above.

6. Turn your notes into a short essay in which you either 1) reflect on the experience of riding the bus to your appointment OR 2) narrate the ride from the perspective of someone you saw on the bus.

Author: Janice Kregor