Student-run Clinic Research Articles

Motivations and Outcomes of Volunteers at a Non-Student-Run Free Clinic

Objective: Free clinics provide free or reduced fee health care services to un- or under-insured individuals in the United States. Volunteers are often the primary human resources of free clinics. Previous studies on free clinic volunteers were conducted at student-run clinics, however, little is known about volunteering at non-student-run free clinics. The purpose of this study is to examine motivations, interests and outcomes among volunteers of a non-student-run free clinic. Methods: Free clinic volunteers (N=184) participated in a self-administered paper or online survey from January to May of 2016. Results: “Values” were the most important motivation and outcome for volunteering. Older age was associated with lower levels of motivation for career, as well as motivation and outcome for understanding and protective function. Longer volunteering was associated with lower levels of motivation for values and careers and of outcomes for understanding. While graduate students were more likely to be motivated by career, undergraduate students were less likely to be motivated by values, compared to non-students. Conclusion: Non-student-run free clinics not only provide educational opportunities, but also potentially a wide range of opportunities for individuals who are interested in community health.

Health Care for the Homeless Transgender Community: Psychiatric Services and Transition Care at a Student-Run Clinic.

Transgender individuals disproportionately experience homelessness and health disparities, including lack of access to gender-affirming care. The student-run Lotus Wellness Center provides care to transgender individuals experiencing homelessness, including primary care, mental health stabilization, and transition via hormone therapy, while medical students learn of the unique health needs of this community.

A Monte Carlo simulation approach for estimating the health and economic impact of interventions provided at a student-run clinic.

BackgroundStudent Run Clinics (SRCs) are a common aspect of medical education, present at more than half of US medical schools, and noted for providing care to communities that might otherwise lack access, including the uninsured and underinsured. To date, few studies have rigorously quantified the health and economic benefits of SRCs, and the present study remedies that.Methods and findingsWe used Monte Carlo simulations to estimate the health impact of common preventive health interventions applied to individuals in quality-adjusted life-years (QALYs). We then used those measurements to estimate the health and economic impact of United Community Clinic (UCC), a student-run clinic in Philadelphia, PA. We found that with an annual operating budget of $50,000, UCC saves 6.5 QALYs, corresponding to over $850,000 saved.ConclusionsUsing Monte Carlo simulation methods, the health and economic impact of SRCs can be reasonably estimated to demonstrate the utility of SRCs and justify their growing importance in the healthcare delivery landscape of the US.

Integrating Behavioral Health Services in a Student-Run Medical Clinic

Integrating behavioral health services into a student-run medical clinic serves multiple purposes. One primary goal of such an initiative is to address the mental health needs of uninsured individuals who are more at risk for mental illness and less likely to seek help than individuals with insurance. An additional objective is to create a venue to train future healthcare providers in integrated healthcare models. This article describes the process of developing and implementing a behavioral health service within a well-established student-run medical clinic. Within the article, issues related to workflow, types of behavioral health services offered, patient recruitment, and clinical supervision are described. The purpose of this article is to explore key lessons learned and to inform other individuals and institutions interested in similarly integrating behavioral health services into current student-run health clinic models.

Measuring and improving student engagement in clinical training

Purpose: Volunteer service learning activities, including Student Run Clinics (SRCs), are becoming an increasingly popular extracurricular component of medical education. While there are reports that student clinicians generally enjoy their educational experiences at SRCs, it is not understood how to optimize and measure student engagement in them. To identify key drivers of student engagement a tool was created to measure volunteer experience at the Crimson Care Collaborative (CCC), a primary care SRC.Methods: CCC volunteers were asked to complete an online engagement survey. Cross-sectional survey data were collected for 149 CCC volunteers (53% response rate).Results: Multivariate linear regression showed that overall ‘likelihood to recommend CCC to a friend’ was significantly associated with students’ perception of the clarity of their role within the clinic, frequency of interprofessional interactions, and overall quality of medical education. Students who volunteer more frequently and for longer periods of time had higher engagement scores.Conclusions: Measuring engagement is feasible in volunteer settings. Engagement appears to be dependent on both structural and experiential components. Easily modifiable components of job design (role definition, expected frequency of volunteering), are key drivers of volunteer engagement.

Improving the Reach Out and Read Program at a Student-Run Free Clinic for Homeless Women and Children

Background: We evaluated the Reach Out and Read program in a student-run clinic serving homeless women and children. Objectives were to improve documentation of book delivery and provision of anticipatory guidance in electronic health records (EHRs) and determine changes in student managers’ knowledge, attitudes, and practices towards pediatric literacy.Methods: We evaluated eligible pediatric visits (N=201) and compared the number of books distributed to patients documented on paper to those documented in SOAP notes, which provides a clinic visit summary in EHRs. Student managers received didactic trainings on pediatric literacy, documentation skills, and ways to train volunteers. Student managers were trained to document that a book was provided to the patient, identify which book was provided, and specify that anticipatory guidance about reading was given to the parent in the SOAP note. Student managers were advised to train other student volunteers in this skill. Pediatric literacy knowledge and attitudes were evaluated before and three months after didactic training. Practice behaviors were evaluated after training. SOAP notes were evaluated six months later to determine improvements.Results: Documentation of book delivery in SOAP notes increased (12.5-77.8%) after didactic training (p<0.001). Significant improvements in students’ literacy knowledge were found (p=0.0201). Most students (67%) practiced reading aloud to patients and asked parents to demonstrate reading. After training, all SOAP notes included the name of the book and that anticipatory guidance was provided.Conclusions: Our results emphasize that training can be effective at improving student managers’ knowledge, attitudes, practices, and documentation skills in student-run clinics.

Improving the quality of care and medical education by involving medical students in providing patient education: a scoping review

Introduction: Studies suggest that quality of care and medical education is increased in student provided patient education. Interventions and outcomes in this field, however, have not yet been systematically reviewed. The authors examined the scientific literature for studies on interventions and outcomes of student provided patient education in a scoping review. Methods: Four databases (MEDLINE, Embase, ERIC, PsycINFO) were searched for studies reporting patient education, undergraduate medical students, and patient-centered outcomes of patient education (patient satisfaction, self-care, health literacy, treatment compliance, health attitude, health behavior, patient empowerment, students’ communication skills, shared decision-making, and relations between (upcoming) care professionals and patients), published between January 1990 and October 2015. Study quality was assessed using the Quality Assessment Tool for Quantitative Studies of the Effective Public Health Practice Project (1). Facilitators and barriers to educational interventions were assessed using the Learning Transfer System Inventory (2). The learning yield, impact on quality of care, and practical feasibility of the interventions were rated by patients, care professionals, researchers, and education professionals based on their personal expertise and rating guidelines. Results: The search resulted in 4,991 hits. Eighteen studies were included in the final synthesis. Study quality was rated weak or moderate. Student provided patient education improved patients’ health knowledge (seven studies), attitude (one study) and behavior (three studies), and enhanced disease management (three studies), medication adherence (one study) and shared decision-making (one study). In addition, involving students in patient education enhanced students’ patient education self-efficacy (four studies) and skills (three studies), relations with patients (two studies), and communication skills (two studies). Experts rated student provided courses, student-run patient education clinics, student provided outreach programs, student health coaching, and clerkships on patient education with high learning yield and high impact on quality of care. Discussion/conclusions/lessons learned: Student provided patient education improves quality of care and medical education. Medical curricula should contain student-run patient education clinics, student provided outreach programs, student health coaching, and/or clerkships on patient education to enhance the quality of care and medical education. In addition, mature roles for students, training preparation, constructive supervision, peer support on organizational and individual levels, and learning aids should be taken into account when implementing student provided patient education to enhance learning effectiveness. Limitations: The search strategy of our review did not include health status as an outcome, because it’s a debatable outcome of patient education interventions. However, as our review shows that disease management is enhanced when patient education is provided by undergraduate medical students, other studies which were not included in this review may show that health status is improved as well in student provided patient education. In addition, we only searched the scientific literature, therefore, examples of integrating patient education and medical education as reported in the grey literature are not described in this review. Suggestions for future research: Future research should be aimed at further investigating the effects found in this study with high-level evidence.

253 Are Demographic Variations Among Homeless Patients Associated With Emergency Department Utilization?

Homeless patients are often perceived to overuse emergency departments (EDs). However, little is known about the variability within this population regarding ED use. In this study, we analyzed the associations between demographic factors in the homeless population and patterns of ED use. A retrospective study using patient databases from SMD and four of Detroit’s major hospitals, Detroit Receiving (DRH), Harper-Hutzel (HUH), Sinai-Grace (SGH), and Henry Ford (HF) hospitals, was conducted. Medical records from a medical student-run street medicine clinic (Street Medicine Detroit - SMD) were matched to the hospitals’ electronic medical records (EMR) one year before and after the initial 2014-2015 SMD encounter using unique patient identifiers. Proportions and means were compared across groups using chi square and t-test statistics respectively. Of 306 SMD patients identified in 2014-2015, 179 (58.5%) had an ED visit within one year of their initial 2014-2015 SMD encounter. Of the SMD patients who also visited the ED, 134 (74.9%) were male. In that same population, 115 (64.2%) were African-American. Among the SMD patients who did not go to the ED, 101 (79.5%) were male, and 98 patients (77.2%) were african-american. The average age of SMD patients who used the ED was similar to that of those who did not use the ED (49.8 years and 49.4 years, respectively). 115 (64.2%) SMD patients utilizing the ED were African-American. 98 (77.2%) SMD patients who did not use the ED were also African-American. Of the patients who visited the ED within one year of their 2014-2015 SMD encounter, 19 (10.6%) had stable living conditions, 66 (36.9%) had unstable living conditions, and 22 (12.3%) lived outside. Of the patients who did not visit the ED, 12 (9.4%) had stable living conditions, 32 (25.2%) were unstably housed, and 12 (9.4%) lived outside. The “unsure” denotation indicates the patient did not specifically disclose their living arrangements. Based on observations of the SMD population, the subset of the homeless who use EDs are more likely to have unstable housing situations, and are more likely to use street drugs. These findings are consistent with previous studies of high ED utilizers, and suggest that only a comprehensive approach, addressing social, physical, and mental health needs of this population will be effective in reducing unnecessary ED use and health care costs.

The role of social work in free healthcare clinics and student-run clinics

ABSTRACTBackground: The role of social work in free healthcare clinics and student-run clinics remains an understudied topic. Method: We conducted a literature review of the published studies through four online databases: Google Scholar, Social Work s, Academic Search Complete, and PsycInfo. Results: The literature review revealed 449 possibly relevant studies, but only nine met the criteria for the final review. Based on these findings, social work is not fully utilized in free healthcare clinics and student-run clinics. Conclusion: Our literature review provides evidence for the need for social work in free healthcare clinics and student-run clinics.

Containing Prescription Drug Costs at a Resource-Limited, Student-Run Clinic for the Uninsured

Prescription drug coverage and reduced medication copayments have been shown to increase medication adherence, improve health care outcomes, and reduce racial and ethnic outcome disparities. This is especially true for uninsured patients who face greater obstacles and cost-barriers in obtaining medications than their insured counterparts. For this reason, some free clinics, including our own, provide medications to patients at no out-of-pocket cost. However, the price of supplying pharmaceuticals and medical supplies at reduced or no cost is a significant financial burden to free clinics, particularly those committed to providing care to the chronically ill, a population whose monthly drug costs can be steep. In this article, we present our free clinic’s evidence-based, value-conscious approach to providing patients with prescription medications at no charge, and evaluate the cost-savings of this operation. Specifically, we highlight the following three strategies and the associated annual savings: implementation of an evidence-based formulary with drug costs available at the point-of-care; the use of Patient Drug Assistance Programs to obtain expensive, off-formulary medications; and utilization of wholesale vendors to obtain blood glucose testing supplies. We present the opportunities, limitations, and lessons learned from this ongoing effort for free clinics to optimize their own drug and medical supply coverage programs.

Foot Exams in a Student-Run Clinic

Background: Chronic diabetes management is challenging in any clinic. A quality improvement study addressed the barriers affecting diabetic foot examination rates in a student-run clinic. Methods: Between February 1, 2013 and December 31, 2015, providers received education about exam components and reminders to perform the exam. Two reminder phases were implemented: 1) inked stamps in the chart and 2) Diabetes Care Forms (a half sheet explaining the exam and streamlining documentation). All encounters for patients with diabetes (451) were retrospectively selected from an internal database for analysis of the presence or absence of chart reminders and diabetic foot examinations. Microsoft Excel was used for basic statistical analysis and chart propagation; SAS was used for chi-square testing. Results: Pre-intervention encounters had an exam rate of 33% (43/107). During the stamp-based intervention between February 1, 2013 and January 31, 2014, the overall exam rate was 78% (86/110, p<0.0001 from baseline) and 90% with the presence of a stamp (81/90, p<0.0005 from pre-intervention). During the Diabetes Care Form (DCF) intervention between February 1, 2014 and December 31, 2015, the overall exam rate was 83% (158/191, p<0.0001 from baseline, p>0.10 from stamp intervention) and 97% for the charts with a DCF (143/148, p<0.0001 from baseline, p<0.05 from stamp intervention).Conclusions: Academic detailing and visual reminders are effective techniques to improve the rate of diabetic foot examinations. A half sheet of paper serving as documentation and as a reminder increased the rate of foot exams in a student-run free clinic with paper charts and rotating clinical staff.

Grand Rounds: A Method for Improving Student Learning and Client Care Continuity in a Student-Run Physical Therapy Pro Bono Clinic.

Background and Purpose. Grand Rounds is a teaching methodology that has existed in various forms in medical education for centuries. When a student-run pro bono clinic identified a growing challenge of providing continuity of care for clients and a lack of preparedness in students, they implemented a Grand Rounds model of case presentation within the curriculum. The purpose of this paper is to describe the implementation and assessment of Grand Rounds as it attempts to improve both the continuity of care for the clients and the learning experience for the students involved in a student-run pro bono clinic.Case Description and Evaluation. The Student Board divided the student physical therapists and the clients into three teams. Each team of students would meet every three weeks to discuss the clients on their caseload. More advanced students helped to mentor the more novice students and a faculty member would facilitate the discussions. Outcomes. After eight months of implementation, the Student Board gathered evaluative data from students, supervisors and client. The program evaluation was approved by the xxxxxxxxxxxxxxx. Analysis of the data collected revealed that the students grew more confident and effective in their ability to implement and advance the physical therapy program. Discussion and Conclusion. The program evaluation confirmed that the implementation of teams and Grand Rounds positively impacted students' confidence and ability to collaboratively treat and advance clients and their physical therapy program in the student-run pro bono clinic. The program evaluation was not effective in thoroughly assessing the impact that the model had on clients and their recovery. Further evaluation should be conducted with client outcomes measures. Recommendations for the modification and improvement of Grand Rounds emerged.

A Medical Student-Run Child and Adolescent Psychiatry Clinic: One Institution's Experience.

This report examines the experience of one institution's development of the first student-run psychiatry clinic that serves both adult and pediatric populations. The clinic is held weekly with pre-clinical and clinical medical student volunteers under the supervision of board-certified adult and child psychiatrists. The development and evolution of the clinic over time are evaluated with particular attention to obstacles overcome. Medical student volunteers were surveyed retrospectively to evaluate their experience with patients with psychiatric illness, skill development, and interest in psychiatry. Since January 2016, the clinic has scheduled 90 patients, 32% of which were pediatric patients. Ninety-six medical students have volunteered, with roughly equal parts from all four medical school classes. Respondents to the experience survey showed marked improvement in their comfort working with patients with mental illness. Additionally, 40% "strongly agreed" or "agreed" that their experience influenced their interest in pursuing psychiatry as a career. This report describes a student-run psychiatry clinic with a dual mission of education and service, and the challenges associated with these sometimes competing goals. This clinic serves a vital need within our community and may be an example of the role that student-run clinics can have in fostering interdisciplinary care, psychiatric recruitment, and training for medical students.

Masterclass Pharmacotherapy: A Succesful and Efficient Concept to Organize Near Peer Pharmacotherapy Teaching

In many European medical schools, the department of pharmacology and clinical pharmacology is often small and staff may think they are not able to deliver a relatively labour-intensive contextual learning programme in (clinical) pharmacology (i.e. role-play sessions, working groups, student run clinics, etc). The aim of this study is to investigate if this ‘problem’ can be resolved by actively involving students in CPT teaching. The section Pharmacotherapy has many years of experience with active student involvement and organizes a masterclass in pharmacotherapy. The master class is for students who have shown particular aptitude during pharmacotherapy training sessions and is led by three student coordinators (who have previously followed the master class). Participants are trained to teach according to the WHO 6-step method and receive additional didactic training for small-group teaching. These participants then give pharmacotherapy training to younger (at least one year below them) students, under the supervision and coaching of experienced teachers. The student teachers are also trained by clinical experts (such as clinical pharmacologists, clinical specialists and pharmacists) to deepen their knowledge and therapeutic reasoning skills with regard to specific clinical cases. Besides explicit training for teaching sessions, other activities are organized for master class participants, such as in-depth sessions on interesting topics such as drugs, toxicology, drug dosing in patients with renal impairment, and visits to drug development facilities. With this concept it is possible to organize 14 differently themed pharmacotherapy training sessions for 350 students divided in 30 groups (2hrs each). These training sessions are organized yearly in medical bachelor year 1-3 and are cost efficient. Student evaluations of these training sessions consistently show high rating scores (average of 4.0-4.3 on a five point rating scale). The Masterclass Pharmacotherapy is a successful and efficient concept to organize near peer pharmacotherapy teaching.

Involving Medical Students in Providing Patient Education for Real Patients: A Scoping Review

BackgroundStudies suggest that involving students in patient education can contribute to the quality of care and medical education. Interventions and outcomes in this field, however, have not yet been systematically reviewed. The authors examined the scientific literature for studies on interventions and outcomes of student-provided patient education.MethodsFour databases (MEDLINE, EMBASE, ERIC, PsycINFO) were searched for studies reporting patient education, undergraduate medical students, and outcomes of patient education, published between January 1990 and October 2015. Facilitators of and barriers to educational interventions were assessed using the Learning Transfer System Inventory. The learning yield, impact on quality of care, and practical feasibility of the interventions were rated by patients, care professionals, researchers, and education professionals.ResultsThe search resulted in 4991 hits. Eighteen studies were included in the final synthesis. Studies suggested that student-provided patient education improved patients’ health knowledge, attitude, and behavior (nine studies), disease management (three studies), medication adherence (one study), and shared decision-making (one study). In addition, involving students in patient education was reported to enhance students’ patient education self-efficacy (four studies), skills (two studies), and behavior (one study), their relationships with patients (two studies), and communication skills (two studies).DiscussionOur findings suggest that student-provided patient education—specifically, student-run patient education clinics, student-provided outreach programs, student health coaching, and clerkships on patient education—has the potential to improve quality of care and medical education. To enhance the learning effectiveness and quality of student-provided patient education, factors including professional roles for students, training preparation, constructive supervision, peer support on organizational and individual levels, and learning aids should be taken into account. Future research should focus on further investigating the effects found in this study with high-level evidence.

Improving Education and Care in Student-Run Clinics: A Didactic Intervention for Pre-Clinical Medical Students

Improving Education and Care in Student-Run Clinics: A Didactic Intervention for Pre-Clinical Medical Students

Patient Expectations and Satisfaction When Using a Student-Run Health Clinic

Background: Promise Clinic, a student-run continuity-based free health clinic affiliated with Rutgers Robert Wood Johnson Medical School, serves the uninsured and low-income population in New Brunswick, New Jersey. Though it has been operating for over ten years, Promise Clinic does not yet have a formalized system for evaluating quality of care from a patient’s perspective. The purpose of this study was to investigate patient satisfaction and expectations at Promise Clinic. Methods: Over a two-month span, we interviewed 21 patients at Promise Clinic. The interview addressed a variety of factors, including patient satisfaction with student doctors, health education and awareness, and understanding of and access to community health options. Furthermore, we elicited open-ended feedback from patients, allowing them to express opinions regarding their healthcare and reasons for attending Promise Clinic over other low-income healthcare providers. Results: We found that while patients were highly satisfied with their overall experience and student doctor teams, there were some concerns about wait times, the timing of clinic, and student doctor preparedness. Patient health education was strong in many, but not all, areas. Of eligible patients, 40.0% reported receiving regular cancer screenings and 33.3% were unaware of other healthcare options. Conclusions: Overall, this study provides a patient-centered assessment of the clinic. Insight obtained has helped medical students and faculty administrators at Promise Clinic address chief patient concerns and improve upon the patient experience. We hope that patient interviews will continue to be a part of quality improvement processes at Promise Clinic and other similar clinics.

Abstract #226: Barriers to Care And Medication Practices for Type 2 Diabetic Patients in a Student-Run Clinic in Montclair; California

Abstract #226: Barriers to Care And Medication Practices for Type 2 Diabetic Patients in a Student-Run Clinic in Montclair; California

Student-Run Clinics: A Novel Approach to Integrated Care, Teaching and Recruitment

The purpose of this study is to assess the educational impact of incorporating a psychiatry consult service into a medical student-run clinic. In November 2014, a psychiatry consult service was introduced at the Columbia-Harlem Homeless Medical Partnership (CHHMP), a student-run clinic located in Harlem, New York. From September 2015 to January 2016, surveys (Qualtrics) were then distributed to student members of the clinic. Surveys assessed how the psychiatric consult service impacted students' knowledge, skills and attitudes about psychiatry. According to survey results (83.8% response rate, n = 31), 100% of students at CHHMP agreed that the psychiatry consult service is a useful addition to the clinic, and 94% agreed that the service helped increase their perceived knowledge of psychiatry. Survey results suggest that having a psychiatry consult service at a student-run clinic is a beneficial educational model in increasing medical students' perceived knowledge and comfort with psychiatry.

Motivation and competence of participants in a learner-centered student-run clinic: an exploratory pilot study

BackgroundThe Learner-Centered Student-run Clinic (LC-SRC) was designed to teach and train prescribing skills grounded in a real-life context, to provide students with early clinical experience and responsibility. The current studies’ theoretical framework was based on the Self-determination Theory. According to the Self-determination Theory, early involvement in clinical practice combined with a high level of responsibility makes the LC-SRC an environment that can stimulate intrinsic motivation. We investigated the different types of motivation and the proficiency in CanMEDS competencies of the participating students.MethodType of motivation was measured using the Academic Motivation Scale and Intrinsic Motivation Inventory. CanMEDS competencies were evaluated by faculty using a mini-clinical examination and by the students themselves using a post-participation questionnaire.ResultsThe 29 participating students were highly intrinsic motivated for this project on all subscales of the Intrinsic Motivation Inventory. Motivation for medical school on the Academic Motivation Scale was high before and was not significantly changed after participation. Students considered that their CanMEDS competencies “Collaborator”, “Communicator”, “Academic”, and “Medical expert” had improved. Their actual clinical team competence was judged by faculty to be at a junior doctor level.ConclusionStudents showed a high level of intrinsic motivation to participate in the LC-SRC and perceived an improvement in competence. Furthermore their actual clinical competence was at junior doctor level in all CanMEDS competencies. The stimulating characteristics of the LC-SRC, the high levels of intrinsic motivation and the qualitative comments of the students in this study makes the LC-SRC an attractive place for learning.