Student-run Free Clinic Research Articles

Assessment of a Student-Run Free Gender-Affirming Care Clinic's Transition to Telehealth.

Transgender and Gender-Nonconforming (TGNC) people continue to experience severe health discrimination and limited access to care. Using survey data collected during August-September, 2020, we report on our findings regarding volunteer provider and patient satisfaction with a student-run free gender-affirming care telehealth clinic at the University of North Carolina at Chapel Hill School of Medicine. We find that patients report overall excellent experiences with telehealth care, primarily due to decreased transportation burden, more efficient use of time, and more frequent communication with student volunteer providers. Our findings show that telehealth is a viable option for student-run clinics in the TGNC community.

26021 Delivering care for the underserved during COVID-19 through real-time teledermatology, a cross-sectional review of patients at a student-run free clinic in Dallas

Background: Student-run free clinics (SRFCs) aid the underserved, however, the pandemic ceased our institutional SRFC operations, similar to 60-70% of SRFCs among 102 reporting institutions. Teledermatology is an attractive solution decreasing the risk of communicable disease for both patients and student volunteers during a pandemic; however, our SRFC lacked a framework. After real-time teledermatology workflow implementation, we present our experience with underserved populations.

25117 Analysis of cutaneous infections in homeless populations at student-run free clinic

Travis Park Dermatology Clinic is a student-faculty collaborative practice that serves to treat dermatologic conditions in homeless and indigent populations of San Antonio. Due to impoverished living conditions, homeless individuals are at risk of developing cutaneous infections with limited access to care. Understanding the trends in this population will aid in planning targeted interventions. We conducted a retrospective chart review using our REDCap electronic medical record to identify patients who were diagnosed with cutaneous infections.

24982 Evaluation of biopsy management at student-run free clinic

Introduction: The Travis Park Dermatology Clinic in San Antonio was established in 2009 as a student-faculty collaborative practice to treat skin conditions in the homeless, indigent, and uninsured population of our community.

25925 Travel burden for free dermatologic care in uninsured and homeless populations

Introduction: The Travis Park Dermatology Clinic is a student-run free clinic that serves homeless and uninsured populations in San Antonio. Being one of the only dermatology free clinics in the Texas, our study aims to evaluate the geographic reach of our clinic and identify the extent of travel burden for dermatologic care within the populations we treat.

Impact of a Checklist on Clinic Flow and Patient Visit Times at a Student-Run Free Clinic

Impact of a Checklist on Clinic Flow and Patient Visit Times at a Student-Run Free Clinic

Unintended Consequences? Assessing the Impact of Curricular Change on Medical Student Participation in a Student-Run Free Clinic.

In a prior qualitative study of the impact of a new (ACE) medical school curriculum, students and faculty reported decreased participation in the student-run free clinic (SRFC) attributed to more intensive scheduling and more frequent testing compared to the previous (Legacy) curriculum. To verify and understand this perception formed during curriculum reform, we conducted a mixed method study to measure student participation in the SRFC before and after curricular change and assessed student beliefs and motivations about SRFC participation using focus groups. Overall SRFC participation did not decrease among students in the ACE cohort following curriculum change. Additionally, both Legacy and ACE groups showed lower participation during test weeks, but the decrease was not significantly different between the ACE and Legacy cohorts. Focus groups confirmed the pervasive misbelief that SRFC participation was indeed lower among ACE students and attributed to reduced student discretionary time plus increased preparation time for frequent testing. Focus groups also revealed several "values" about volunteering at the SRFC which should be endorsed and promoted by schools considering curricular change. Participants valued the SRFC for educational items that were most effectively taught in the SRFC, notably social determinants of health, interprofessional practice, and interviewing with medical interpreters. They also valued the SRFC for professional validation, opportunities to apply course content, practice clinical skills, form important professional relationships, and provide community service. Our findings validate the value of SRFC experience as reported by students and demonstrate that, contrary to misbeliefs, participation was not negatively impacted by curricular reform.

Improving Medical Student Clinical Knowledge and Skills Through Influenza Education.

This project aimed to implement a rigorous evaluation of influenza vaccine education as a learning tool for influenza and medical knowledge and clinical proficiency. Among 280 Stony Brook University first-year medical students, 80 were randomly selected to participate in the Stony Brook influenza vaccine education program. Participants completed an anonymous pre-survey assessing participants': (1) experience and attitudes towards flu vaccines, (2) knowledge base of the flu virus and vaccine, (3) self-rated knowledge of the flu virus and vaccine, and (4) self-rated proficiency of clinical skills relevant to administering flu vaccines. Students then completed an educational module and vaccinated either employee healthcare workers or patients at a student-run free health clinic. Following the vaccination experience, participants completed a post-survey including questions identical to those on the pre-survey and questions regarding their evaluation of the flu vaccine education program. The pre- and post-survey data were paired, established through matching surrogate study identification codes, and differences between survey responses were analyzed using paired t-tests. Eighty first-year medical students participated in the pre-survey, while 55 participated in the post-survey. Compared to the pre-survey, participants significantly improved their knowledge base related to the flu virus and vaccine as well as their self-rated knowledge and clinical skills, in the post-survey. The Stony Brook influenza vaccination program succeeded in establishing medical student training and practice with service learning. Our study is the first to provide quantitative evidence of influenza vaccine education programs improving medical student knowledge and clinical skills. The online version contains supplementary material available at 10.1007/s40670-021-01355-2.

Student-run free clinic volunteers: who they are and what we can learn from them

BackgroundInitiatives employing medical students’ volunteerism and idealism, such as the Student-Run Free Clinics (SRFC) program, are prevalent in US medical schools. Many studies evaluated various aspects of volunteering, sometimes resulting in conflicting evidence. This study simultaneously sought to identify the characteristics of volunteers vs. non-volunteers, and to characterize the volunteers’ perception of the SRFC.MethodsWe administered a survey to the Long School of Medicine (LSOM) Class of 2018 before their third year of medical school. The authors compared and contrasted the findings of the SRFC volunteers with their non-volunteering counterparts by analyzing their demographics, volunteering history, academic performance, and clinical skills. The volunteers were also asked about their SRFC experiences.ResultsWhile most volunteers were female (62 %) and non-traditional students (67 %), the difference was not statistically significant (p = 0.15 and p = 0.38, respectively). Additionally, there were no statistically significant differences between the two groups in measures of academic performance (p = 0.25). Most of the volunteers learned about the SRFC program prior to starting medical school. Further, while SRFC volunteers were more likely to engage in additional local volunteering initiatives, the difference was not statistically significant (p = 0.03, prespecified α= 0.006). Importantly, volunteers agreed/strongly agreed that SRFC volunteering emphasized aspects that were missing or underemphasized in the formal medical school curriculum.ConclusionsMedical students’ age, gender, undergraduate major, and non-traditional status were not statistically different between volunteers vs. non-volunteers. However, there may be tendencies for volunteers to be female, non-traditional, and locally engaged. Further, the timing of knowledge of the SRFC program may not affect student involvement in the SRFC, either. Most importantly, however, while volunteering does not affect the students’ academic performance, it may provide improvements in clinical competencies.

Using Social Determinants Screening/Mapping Tools to Identify Needs and Resources for Student-Run Free Clinic Patients

Background: Social determinants of health have been well accepted as contributing to health outcomes. They are a vital aspect of health care delivery and must be a consideration, especially among free clinic populations. Social determinants of health have also become a required element of medical school curricula. The Student Outreach to Area Residents Student-Run Free Clinic based out of Northeast Ohio Medical University piloted a student-led program that implemented social determinants of health screening and community resource referral as a part of integrated health care delivery for all its patients. Methods: We described the development of a screening tool, protocol, and creation of community resource referral materials. We also described the tracking of patient-reported needs and mapping of location and accessibility of community resources. One hundred patients were surveyed through convenience sampling, and results were used for program improvement. Results/Conclusion: After collecting and analyzing survey results, it was found that the 2 most frequently requested determinants were mental health and utilities services, and the most available community resource was emergency food services. We also mapped these results by zip code and found gaps between need and distribution of services. We demonstrated the utility of mapping to identify points of improvement for the future. We also provided lessons learned related to effective social determinants of health screening, community resource referral, and overall program implementation in student-run free clinics. We further explained the benefits of including similar student-led programs as a way for students to gain practical experience related to social determinants of health.

Toledo Naloxone Outreach Program: Patient and Health Care Professional Student Education

Background: In 2016, Ohio was home to 2 of the top 10 cities with opioid overdoses in the United States. Dayton ranked first, and Toledo held the tenth slot. In response to the opioid epidemic, the Toledo Naloxone Outreach Program (TNOP) was developed to provide naloxone to underserved patients at a student-run free clinic.Methods: The TNOP takes place weekly at 2 locations in the greater Toledo area. Patients are asked to fill out an anonymous survey and given a brief training session by a health care professional student. Patients are then sent home with a free naloxone kit. Additionally, health care professional students were surveyed on their confidence of acquiring a substance use history and knowledge of local services for patients and family members of those experiencing addiction during the "train the trainer" event. The health care professional student survey utilized a 1-5 Likert scale and was analyzed using paired student t tests.Results: Survey results from patients indicate that a majority had not received nalox one prior to the training, indicating the service was expanding access to an otherwise underserved population. Results from the survey administered before and after health care professional student training sessions reflect a significant increase in confidence eliciting a substance abuse history and providing patients and/or family members with addiction resources in the community.Conclusion: The TNOP has provided the community of Toledo with 2 additional outreach locations for receiving free naloxone kits with proper education. Currently, TNOP is in the process of expanding the outreach program to additional student-run free clinics in Ohio.

Starting a Free Ultrasound Clinic for the Underserved: Considerations and Overcoming Challenges

Many radiologists are interested in providing affordable care to underserved populations but are unsure how to accomplish it. We present a model for providing imaging services to the underserved with an emphasis on the challenges we encountered and strategies we used to overcome them. In partnership with our medical school's student-run free clinic, we developed a community-based ultrasound service that provides diagnostic ultrasound examinations to an uninsured urban population to address the need of timely access to care and integrated follow-up care. Image storage and reporting were fully integrated with our existing imaging informatics and electronic medical record systems. Radiology residents play a central role in the operation of the service while gaining hands-on ultrasound experience, in partnership with volunteer sonographers, radiology attendings, and medical students.

Exploring Effectiveness of Online Nutrition-Related Diabetes Education Training for Interdisciplinary Healthcare Students at a Student-Run Free Clinic

ObjectivesThe objective of this project was to explore the effectiveness of online nutrition-related diabetes education training for interdisciplinary healthcare students volunteering at a student-run free clinic (SRFC). Providing online nutrition-related diabetes education training to interdisciplinary healthcare students at a student-run free clinic may increase participants’ familiarity with and confidence in providing nutrition-related diabetes education to patients. MethodsStudent volunteers (n = 16) at a SRFC watched an online training video on nutrition-related diabetes education. Topics covered in the training video included the relationship between diet and type 2 diabetes, and the use of motivational interviewing and SMART goals to counsel patients with type 2 diabetes. Using a pre-test/post-test design with eight Likert-scaled (strongly disagree to strongly agree) items, students rated statements indicating familiarity with and confidence in providing nutrition-related diabetes education to patients. Wilcoxon signed-rank tests were conducted to test for statistically significant shifts in each Likert-scaled item pre- to post-test. Statistical significance was set at P ≤ 0.05. ResultsResults showed an overall positive shift in response ratings from the pre- to post-test for all Likert-scaled items. Seven of the eight sets of results had a statistically significant positive shift in response rating (P values < 0.05). ConclusionsFindings indicate that providing online nutrition-related diabetes education to interdisciplinary students volunteering at a SRFC has potential to increase their familiarity with and confidence in providing nutrition-related diabetes education to their patients with diabetes. Funding SourcesNo funding was received.

Impact of Adverse Childhood Experiences in a Student-Run Free Clinic Population

Impact of Adverse Childhood Experiences in a Student-Run Free Clinic Population

Evaluation of a Preventative Health Consultation Service for Patients at Student-Run Walk-In Health Clinics

Background: Preventative health services are often underutilized by under-resourced populations. This study aimed to evaluate the utility of a student-run preventative health consultation (PHC) service at free walk-in clinics.&#x0D; Methods: This prospective cohort study recruited adult participants from student-run free walk-in clinics at a Spanish-language church and a homeless shelter. During the PHCs, recommendations from the United States Preventative Services Task Force and Centers for Disease Control and Prevention immunization schedule were discussed with participants. The top three recommendations for each participant were prioritized using shared decision-making. Participants completed a post-PHC survey and were contacted within three months about recommendation completion status. Recommendations were grouped into categories and analyzed using descriptive statistics.&#x0D; Results: Of the 29 people enrolled in the study, 48% (n=14) were Spanish-speaking, and 45% (n=13) were homeless/displaced. There were 87 recommendations made and categorized as health behaviors (29.9%, n=26), vaccinations (18.4%, n=16), chronic disease screenings (18.4%, n=16), communicable disease screenings (17.2%, n=15), cancer screenings (11.5%, n=10), and other (4.6%, n=4). The most common completed recommendations were changes in health behaviors (46.2%, n=12) and chronic disease screenings (37.5%, n=6). Of the participants who completed the post-PHC survey, 96% (n=27) agreed or strongly agreed they learned new information about their health from the PHC, and 100% (n=29) reported being glad to have engaged in the PHC and that the PHC service should continue at the monthly clinics.&#x0D; Conclusions: Health behaviors, vaccinations, and chronic disease screenings were the most frequently prioritized preventative health needs. Student-run PHC services may offer a way to increase underserved patient knowledge and engagement with preventative healthcare.

Is Stability Sufficient? Challenging the Status Quo via Needs Assessment in a 22-Year-Old Student-Run Free Clinic

Is Stability Sufficient? Challenging the Status Quo via Needs Assessment in a 22-Year-Old Student-Run Free Clinic

Ophthalmology Services at Student-Run Free Clinics: A National Survey

ImportanceStudent-run free clinics (SRFCs) primarily service the uninsured and are a unique way for medical students to gain hands-on exposure to ophthalmology. The free clinic model takes many different forms- some with episodic and longitudinal models-- and this is mirrored in corresponding eye services. ObjectiveTo describe SRFC ophthalmology services nationwide. DesignThis was a telephone survey study administered from June through July of 2018. SettingThis study surveyed medical school SRFC clinics across the United States. ParticipantsSurvey request was sent to 19 SRFCs previously identified as having ophthalmology services via internet search. Fourteen SRFCs (73%) participated; participants were either student clinic leaders or medical directors. One respondent no longer had a distinct eye clinic so was excluded from relevant results. Main Outcome and MeasureCharacteristics of ophthalmology SRFCs including participants, frequency of sessions, common diagnoses treated, and challenges encountered were assessed through this survey. ResultsOn average, each SRFC provided 5.15 hours per month of ophthalmology services. The mean number of medical students involved per session was 8.7. Lack of infrastructure to ensure adequate patient follow-up and faculty recruiting were cited as the main challenges in providing ophthalmology services. Most SRFC leaders indicated exposure to ophthalmology and practice with the exam as the main experiences that students sought and achieved. The most common conditions treated were refractive error (92.3%) and diabetic retinopathy (69.2%). ConclusionThere are a small number of SRFCs that have ophthalmology services, and they share common features in terms of participants, staffing, and, barriers to sustainability. Ophthalmology services at SRFCs offer a unique venue for medical students to gain exposure to an under-represented field in medical school curricula. The growth of this critical venue for medical student training could be enhanced by recruitment strategies aimed at ophthalmology faculty with a strong interest in service and teaching.

Cost Savings of HPV Testing Alone Versus Co-Testing for Cervical Cancer Screening at a Student-Run Free Clinic

Background: Primary high-risk human papillomavirus (hrHPV) testing is an approved alternative method of cervical cancer screening by the United States Preventative Services Task Force. The University of South Florida BRIDGE (Building Relationships and Initiatives Dedicated to Gaining Equality) Clinic is a student-run free clinic with limited screening resources, serving patients below the poverty line. This study aimed to determine the potential cost benefit of primary hrHPV testing in this population.&#x0D; Methods: A retrospective observational study of clinic invoices and patient charts from January 2014 to December 2018 of women receiving cervical cancer screening by co-testing was performed. &#x0D; Results: BRIDGE spent $29,122.37 on screening over the five-year period for 128 patients. By elimi-nating cervical cytology, the clinic would have saved $11,594.34. Fifteen patients had abnormal results, ten of which were hrHPV-positive.&#x0D; Conclusions: The $11,594 saved would allow BRIDGE to screen 110 more patients by primary hrHPV testing and another three by eliminating follow-up for atypical squamous cells of undetermined significance, hrHPV-negative results. One patient with low-grade squamous intraepithelial lesion and negative hrHPV represents a 0.8% risk of missing precancerous lesions the clinic would assume by adopting primary hrHPV testing.

Implementation of a Mental Health Screening Tool at an Adult Homeless Shelter Student-Run Free Clinic in Arizona

Background: Mental health conditions are prevalent in people experiencing homelessness. This population may seek care in student-run free clinics (SRFCs), but screening for mental health conditions may not be consistent in this setting. The primary objective of our study was to implement a screening tool and determine the gap in identifying mental health conditions between History and Physical (H&amp;P) examinations and the new screening tool. Secondary objectives were to assess its impact on patient volume and workflow.&#x0D; Methods: Adult patients at a homeless shelter-based SRFC completed a mental health screening survey, separate from acute-care visits, aimed at identifying “high-risk” mental health conditions using validated questionnaires for identifying domestic violence, alcohol use, depression, anxiety, and mood disorders. Chart review was conducted to identify concordance between patients who screened positive for a high-risk condition using the survey and those with a high-risk condition documented in the acute-care H&amp;P. Visit volume was tabulated and compared between the pre- and post-intervention periods using a t-test. A survey for volunteers was used to gather experiential feedback.&#x0D; Results: Of 354 patients treated at Central Arizona Shelter Services, 123 (34.7%) were evaluated by the research team. Sixty (48.8%) of screened patients were identified as high-risk for at least one mental health condition through the screening tool, and 26 (43.3%) charts were reviewed. Of the patients that were screened as high-risk and reviewed, 15 (57.7%) were not documented as high-risk in the acute-care visit H&amp;P. The clinic volume averaged 11 patients, regardless of whether screening occurred during clinic (p = 0.95). Of clinic volunteers, 191 (97.4%) reported no noticeable impact on clinic operations.&#x0D; Conclusions: The screening survey identified more cases of mental health conditions than the previous standard medical interview. There were no adverse effects on the clinic workflow.

Cultural Sensitivity and Learning About Healthcare Equity for the Underserved: Experiential Learning in a Student-Run Free Clinic

With increased diversity in the USA comes a growing need to educate medical students on how best to manage diverse patient populations. Medical students on the board of a student-run free clinic (SRFC) were surveyed to determine how such a leadership experience might alter students' cultural sensitivity as it relates to healthcare equity. Forty-six students (42.2% response) reported their experiences helped them better understand patient's needs (4.37, 0.64; mean, SD), cultural barriers (4.44, 0.55), and racial/ethnic disparities (4.27, 0.70). Thus, service on the board of a SRFC improves cultural sensitivity.