The Value of Student-Run Free Clinics for Patients, Students, and the Community

From the February 3, 2023 issue of the Transformational Times

The Value of Student-Run Free Clinics for Patients, Students, and the Community

By Rebecca Lundh, MD, SCU Medical Director  

and Staci Young, PhD, SCU Research and Finance Director 

 

Supporting tomorrow’s leaders in healthcare equity, these clinics offer patient-centered care and rewarding experiences for students... 

 

Saturday Clinic for the Uninsured (SCU) is MCW’s student-run free clinic. Under faculty supervision, medical and pharmacy students are responsible for day-to-day operations and participate in providing patient care and education. Our motivation and inspiration for supporting and advising students at SCU stem from a commitment to health equity and social justice. We believe people have a right to quality healthcare, which means providing holistic and comprehensive care that addresses the diverse health needs and goals of each patient. Through the years, we strive to do this, together with thousands of medical and pharmacy students and hundreds of faculty members full of energy and passion.  

 

 

Some History: 

 

SCU began in 1991 as the Isaac Coggs Saturday Clinic for the Uninsured, housed in a federally qualified health center to meet primary healthcare needs of Milwaukee patients without access to healthcare because they lack insurance and financial resources. In 2001, SCU affiliated with community partner, Columbia-St. Mary’s, now Ascension Wisconsin, to continue this mission. Support and collaboration with health systems and other organizations is critical for free and charitable clinics to connect patients to clinical and community resources. SCU has been very fortunate to have these partnerships to provide care.  

 

Over the past 30 years, the clinic has shifted from providing care on a first-come, first-served basis to patients who would spend hours waiting in lines outside the clinic before it opened, to care that is more patient-centered – meeting patients where they are and providing what they need for their health. Through student-led efforts, SCU has expanded its clinic services. It now provides telemedicine and many specialty services in-house, including pharmacy, ophthalmology, psychiatry, dermatology, neurology, and many others. 

 

 

Student Experience:  

 

MCW students have operated the clinic since the beginning, performing tasks from administration to direct patient care under the supervision of volunteer physicians, pharmacists, and faculty advisors. Even though they do not receive academic credit, hundreds of medical and pharmacy students still volunteer on a rotating basis each school year. 

 

SCU holds incredible value as one of the first, and commonly the only, opportunity early medical students get to work one-on-one with patients. Students learn to apply their medical knowledge and skills in a supervised learning environment without the added pressure of educational or time restrictions in clerkships. Students also learn how to care for patients of different cultural, racial, or socioeconomic backgrounds. Many SCU patients have complex needs, and although addressing these can be challenging, it can be highly rewarding and useful for their training. For many students, the clinic provides their first experience addressing social determinants of health (SDOH) and is a tangible reminder of why they are working diligently on their education. 

 

 

Student-led Research Efforts: 

 

The research arm of SCU has grown and become stronger over the years. Student projects have demonstrated that health and wellness needs vary across patients and populations. Research findings add value and community benefit by providing evidence for tailoring resources and care toward the specific needs of patients.  

 

For example, identifying and addressing SDOH are important aspects of healthcare and wellness. However, without appropriate screening we may not know the extent of patients’ needs, such as financial or food insecurity. Thus, we become focused on medical management of the condition rather than the root cause of the problem. Years ago, we supported a pathway project to address SDOH that has evolved into a robust program with trained volunteers to screen and assist patients in real time with SDOH using an organized resource bank. This program also includes patient follow-up to evaluate the utility of these resources and to make changes to the resource bank as needed.  

 

Another student-led initiative is the newly formed Patient and Family Advisory Council (PFAC) that has been a growing source of feedback on current services we provide at the clinic and proposals for the future. The (PFAC) has helped provide ideas to improve patient understanding of SCU services and processes and input into student volunteer training. We will evaluate the experiences of individuals in the PFAC to inform future recruitment and meaningful participation.  

 

We will continue to support research efforts and translate findings into innovative ways of delivering care to uninsured individuals to promote overall health and wellbeing. Through these projects (and others), we aim to be a holistic, community-engaged clinic that is welcoming and reliable for our patients. Our vision moving forward is to amplify our work that benefits both the community and MCW. 

 

 

Envisioning the Future:  

 

We consistently see that many of our students value delivering care for patients with a multitude of needs, and SCU provides this opportunity. We are grateful for the enthusiasm and dedication of these students and constantly inspired by their commitment and ideas. The articles shared in this issue showcase student leadership and reflections, and some of their initiatives.  

 

As mentors in clinical care, research, and community engagement, our hope is that students remember their time at SCU and hold on to the values and lessons they learned as they continue in their training and future practices. In time, we are optimistic that we will see changes in the healthcare system that promote health equity and provide quality care for all individuals as we support tomorrow’s leaders in healthcare and medical education.  

 

 

Rebecca Lundh, MD is an Assistant Professor of Family and Community Medicine and Medical Director for the Saturday Clinic for the Uninsured at MCW. She previously volunteered at SCU as a medical student and resident. 

 

Staci A. Young, PhD is a Professor of Family and Community Medicine and Director of Research and Finance for the Saturday Clinic for the Uninsured. She is also the acting Senior Associate for Community Engagement at MCW. 

 

We would like to acknowledge Suma Thareja, PhD for collaborating with us to write this article and facilitating the compilation of the February 3, 2023 issue of the Transformational Times. 

 

  

Gold Foundation Essay Contest Open - Deadline March 13, 2023

2023 Hope Babette Tang Humanism in Healthcare Essay Contest is now open Deadline: March 13, 11:59 p.m. PT

Medical and nursing students are invited to enter The Hope Babette Tang Humanism in Healthcare Essay Contest and engage in a reflective writing exercise around an experience of humanistic care. This year’s essay prompt is an excerpt from "How Far Away We Are," a poem by U.S. Poet Laureate Ada Limón: "I want to give you something, or I want to take something from you. But I want to feel the exchange, the warm hand on the shoulder, the song coming out and the ear holding onto it.”  Six winners (three medical students and three nursing students) will receive a monetary award ($1,000 for first place, $500 for second place, and $250 for third place). Their essays will be published in Academic Medicine, the journal of the Association of American Medical Colleges, and The Journal of Professional Nursing, of the American Association of Colleges of Nursing.

Learn more

About Dr. Hope Babette Tang The essay contest was named in honor of Hope Babette Tang-Goodwin, MD, an Assistant Professor of Pediatrics. Her devotion and generosity to the care of the children and infants with HIV infection in New York City was an inspiration to her colleagues and her students. Her approach to medicine combined a boundless enthusiasm for her work, intellectual rigor and deep compassion for her patients. In sum, Dr. Tang-Goodwin was an exemplar of humanistic care.

Essay Contest Details Essay contest participants engage in a reflective writing exercise that illustrates an experience where they or a team member worked to ensure that humanism was at the core of care. Submissions that touch upon students' personal experiences of humanistic care or stories of family and friends will also be accepted. Essays should be 1,000 words or fewer. Judges will be looking for essays that connect strongly to the Gold Foundation’s mission of humanism in healthcare for all. Winning essays will illuminate how the human connection can make a meaningful difference in care. The essay contest is open to medical students at accredited schools of medicine in the U.S. and Canada and nursing students at AACN member schools. Students at international medical schools that have a Gold Humanism Honor Society (GHHS) chapter are also eligible. For more information on contest rules and eligibility, please visit our website. Submissions are due Monday, March 13, at 11:59 p.m. Pacific Time.

Submit your essay

13,000 Days on the Hamster Wheel: Finding Meaning on the Way to Retirement

Adapted from a version in the 8/21/2020 issue of the Transformational Times

 

 

13,000 Days on the Hamster Wheel: Finding Meaning Before and After Retirement

 

 

Bruce H Campbell, MD, FACS 

 

In this essay first published in the Transformational Times in 2020, Dr. Campbell reflects on how the self-care trajectory on which we place our students and residents will carry them beyond their careers …

 

Medicine differs from many other professions. Once a physician joins a practice, it is possible to become a perpetual-motion machine, working day-after-day, seeing patients and generating revenue. As long as the physician directly or indirectly generates enough cash flow to pay salaries, keep the lights on, and move the enterprise forward, the process can continue unabated. Theoretically, this hamster-on-a-wheel activity can continue for around 13,000 days. That’s thirty-five years. Then the hamster retires, and another is recruited to keep the wheel turning. 

Of course, I don’t usually view myself, our students, or our residents as hamsters, but there have been days when the thought crossed my mind. Still, what can medical educators do to prepare the next generation of physicians in ways that will enrich – rather than deaden – their lives and careers? And how do we help our trainees step back and begin to grasp the arc of their journeys from graduation to retirement?

 

Talking with trainees about their careers

A couple of years ago, I held a session on retirement with our otolaryngology residents. We read an article where the authors asked brand-new Johns Hopkins internal medicine interns to write down and then share what they thought a colleague would say about them at their retirement celebration many years down the road. I asked our residents to do the same. We also discussed which of their character strengths would be most noticeable in their careers (from the list at www.viacharacter.org/), what they think they will miss about their careers after they retire, and what aspects of retirement they are thinking about now. 

Not surprisingly, the Hopkins medical interns in the article and our MCW otolaryngology residents all see the distance from where they are now to retirement as being an incredibly long time. The brand-new interns hoped that their colleagues would see that they had lived out their core values, been accomplished in their careers, and been good teammates. Among possible character traits, our residents hope that they would have been most admired for their dedication to teamwork and their humility. They anticipate that they will find their greatest personal satisfaction–and what they think they will miss the most–from being part of a team focused on helping others in times of great need. Like the interns in the study, our residents worried about retirement but, being so far off in the future, they could not imagine what it will feel like to get there.

 Our otolaryngology residents did differ from the internal medicine interns. Although they know they will miss many things, they believed they will be able to replace professional relationships, the joy of helping others, and stimulating conversations with other post-retirement activities. As surgeons, though, they worried that they will have difficulty replacing the unique privilege of performing surgery. As one resident said, “I can’t imagine not operating again. That’s why we went into this.” Many agreed. 

 Our otolaryngology residents, who had been in training much longer than the brand-new interns in the Hopkins study, focused on how quickly time passes, even in training. “I am already realizing how much I will miss my fellow residents,” one of senior resident noted. “I’m sure my career will seem to pass by just as quickly.”

 

The challenges of helping students, residents, and faculty gain insight into themselves and others

There are data that strong relationships and lifelong self-care habits can yield benefits much later in life. MCW faculty members and the Kern Institute are building a portfolio of curricular and extracurricular opportunities that encourage resilience and insight.  The challenge is to make these types of offerings available, appealing, and effective. Baking caring and self-care into the institutional culture and the curriculum creates opportunities for both transformation and scholarship. 

But, let’s get real 

Finding time for reflection, creativity, and long-range personal planning is difficult and, frankly, of low priority for busy students, residents, and faculty. Institutions can readily measure clinic slots, RVUs, grant funding, and fiscal margins, but we don’t (yet) have metrics that measure sustained empathy, strengthened character, prevented suicides, and successful prevention of burnout. If we cannot demonstrate that these habits can be nurtured, or if they aren’t seen as valuable, our interventions will have little impact and won’t be sustained. 

Yet, raise your hand if you think that a graduate who is unprepared to thrive in practice will suffer needlessly over the coming decades. 

  

Retirement isn’t for sissies

Over the years I have been at MCW, dozens of colleagues have retired. The end of a career rarely goes exactly as planned. Some have retired amid accolades for lives and careers well-spent while others have left baffled and reluctant, having no idea what they would be doing a week later. Some, after long and productive careers, were forced out after bitter disputes. Some packed up and left in disgrace. Some became ill or died before they had the opportunity to retire. Some, unfortunately, held on too long. Some left huge holes in the institution when they retired. Others barely caused a ripple. 

 Guiding our students and trainees toward rewarding careers and eventual retirements carries responsibility. We must do more than suggest they be financially responsible and keep track of their retirement account outlook. We have equally important responsibilities to help them develop well-rounded professional identities, “seize the day” mentalities, and careers as reflective, empathic, and mindful physicians. If they enter practice self-aware and focusing on character, caring, and practical wisdom, they should have a better chance of emerging into retirement possessing the same values. 

 

Living each day

The act of living intentionally came to mind when I read a story in an interview with Duke University’s director of medical humanities, theologian, and pediatric oncologist, Raymond Barfield, MD: 

 “Think of each day as a gold coin that you are required to trade for something. You’ll never get that coin back, so whatever you trade it for had better be worth it. You also don’t know how many coins you have left to trade, and you don’t know what will happen when your bag is empty.”

My career shot past me like a rocket since I completed my fellowship and joined the MCW faculty 12,945 days ago. I now wish I had learned early on to treat each day like a gold coin. 

As I look back on my clinical practice, there were too many “hamster on a wheel” days. Still, I am grateful for the moments when a colleague or mentor, some of whom have died, encouraged me to take advantage of the self-care and reflective skills I acquired along the way. It helped. A lot.

Here is hoping we all learn to pay it forward. Your retirement will be here before you know.

 

Bruce H Campbell, MD, FACS, is a Professor in the Department of Otolaryngology and Communication Sciences and in the Institute for Health and Equity (Bioethics and Medical Humanities) at MCW. He is on the Faculty Pillar of The Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. He serves on the editorial board of the Transformational Times.