Evaluating the Relationship Between Participation in Student-Run Free Clinics and Changes in Empathy in Medical Students

The Chicagoland Free Clinics Consortium: A Model for Student-Run Free Clinic Collaboration

BACKGROUND

While student-run free clinics (SRFCs) play an important role in care for underserved populations, few mechanisms exist to promote collaboration among regional SRFCs.

AIMS

To address this gap, the Chicagoland Free Clinics Consortium (CFCC) was formed to (1) facilitate collaboration between Chicagoland SRFCs, (2) provide innovation grant funding, and (3) host an annual conference.

SETTING AND PARTICIPANTS

In 2018, students from the Pritzker School of Medicine founded the CFCC and partnered with peers from area schools to implement programming.

PROGRAM DESCRIPTION

Between 2018 and 2022, CFCC engaged 23 SRFCs representing all 6 Chicagoland schools, held 4 annual conferences, and distributed $15,423 in grants to 19 projects at 14 SRFC sites.

PROGRAM EVALUATION

A total of 176 students from 5 schools attended the 4 conferences. In 2022, 82 unique participants were surveyed, and 66% (54/82) responded. Eighty percent (43/54) reported they were "more likely to collaborate with other Chicagoland free clinics." In 2022, all grant sites were surveyed and 84% (16/19) responded. Most (87%,14/16) agreed the grant "allowed them to implement a project that would not have otherwise been accomplished" and 21% (4/19) were inter-institutional collaborations.

DISCUSSION

To our knowledge, CFCC is the first student-led organization to promote sustained collaboration across SRFCs in a metropolitan area.

Impact of student-run clinic participation on empathy and interprofessional skills development in medical and pharmacy students

Background

Students participating in student-run clinics (SRCs) have opportunities to develop and practice beneficial skill sets, including empathy and interprofessional collaboration.

Objectives

This study aimed to assess whether participation in an underserved SRC impacts the development of empathy and interprofessional skills in pharmacy and medical students.

Methods

This study assessed empathy and interprofessional skills development through a self-assessment survey. The survey included the Interpersonal Reactivity Index (IRI) to assess empathy, the Attitudes Towards Health Care Teams/Team Skills Scale (ATHCTS/TSS) to assess interprofessional team dynamics, and a free-text response section. Participants were grouped based on whether they participated in the SRC (intervention group) or did not participate in the SRC (control group). A subgroup analysis was performed based on the participants' discipline (medicine vs. pharmacy). To compare differences in IRI, ATHCTS, and TSS scores between study groups, independent samples t-tests were performed. A thematic analysis was used for qualitative data.

Results

There were no statistically significant differences between intervention and control groups in IRI, ATHCTS, or TSS scores. Subgroup analyses showed no significant differences in scores of student pharmacists or medical students. For both disciplines, the thematic analysis revealed the most common positive themes identified were "real-world patient interaction and care," "impact on practice/career development." Alternatively, it revealed the highest reported negative themes identified as "time management and operational difficulties" and "concerns about the quality of/access to care".

Conclusions

This study demonstrates that involvement in an SRC neither improves nor hinders a learner's development of empathy and interprofessional team skills. Qualitatively, students reported that participation in an SRC benefited their learning and helped develop their skills, like empathy and team dynamics, in an interprofessional setting. Future research with longitudinal monitoring or alternative assessment tools is recommended.

Student Faculty Collaborative Clinics Influence on Emergency Department Use

Student-faculty collaborative clinics, like the Crimson Care Collaborative (CCC), provide primary care access to underserved communities. Affiliated with a community health center, CCC-Chelsea serves a largely immigrant and refugee population. This study aimed to analyze patients' reported ED use before and after they presented to CCC-Chelsea and whether types of insurance affect ED use. We prospectively surveyed 229 patients presenting to CCC-Chelsea between 2013 and 2019. Patients who presented for two or more visits at least one year apart were included in the study. A two-sided Wilcoxon signed rank test was used to compare reported ED use before and after presenting to CCC-Chelsea, and a Kruskal-Wallis test analyzed the association between ED use and insurance status. Most patients (77.7%) presenting to CCC-Chelsea identified as Hispanic, 70.9% were male, 50.6% of patients reported an income of less than $15,000 yearly, and 30.4% had an income between $15,000-$30,000. Most patients (51.9%) did not specify the type of insurance used, followed by public insurance (36.7%), with the remaining having private or no insurance. Results from our survey showed that patients who returned to CCC-Chelsea reported a decrease in the average number of yearly ED visits after attending CCC-Chelsea (pre-CCC 1.544, post-CCC 0.696, p < 0.001 at the 95% CI). There was no difference in reported average number of ED visits yearly and insurance type (p = 0.579). Patients' reported ED utilization after accessing care at CCC-Chelsea decreased. Increased access to student-faculty collaborative clinics could reduce ED use in underserved populations.

Learning Outcomes from Participation in Student-Run Health Clinics: A Systematic Review

Student-run clinics (SRCs) offer unique opportunities for students to engage in healthcare delivery, but the student learning outcomes of such clinics have not yet been systematically examined in a comprehensive manner. The purpose of this review was to appraise and synthesize existing literature pertaining to student learning outcomes associated with participation in SRCs. A systematic review was undertaken using PubMed, CINAHL, and Web of Science databases. The quality of articles that met inclusion criteria articles was appraised using the Mixed Methods Appraisal Tool (MMAT). Study details, such as learning outcomes, were also extracted. Ninety-two studies met inclusion criteria. Most studies were conducted in North America (n = 73, 79.3%), and related to clinics involving solely medical students (n = 35, 38.0%) or multi-professional clinics (n = 34, 37.0%). Demonstrated learning outcomes of SRC participation include clinical skills, interprofessional skills, empathy/compassion for underserved patients, and leadership. SRC participation had little apparent impact on students' future career directions. Quality appraisal via the MMAT found mixed levels of research quality amongst reviewed studies. In summary, while SRC participation appears to offer benefits for student learning, improved study design and research outside of North American contexts would further advance knowledge.

Empathy and the Medical Student House Call: The Effect of Clinical Settings on Empathy in Third Year Medical Students

Objective

This study measured the effect the experience of house calls might have on third-year medical students.

Methods

Students were surveyed via an anonymous online survey at the start of their geriatrics clerkship, again at the end of their clerkship, and once more three months later. Empathy was measured using the Jefferson Scale of Empathy - Student version (JSE) and student attitudes towards the geriatrics population was measured using the UCLA Geriatrics Attitudes Scale (GAS). Data were analyzed using SPSS version 27.0.

Results

No changes in empathy were found when comparing students who completed house calls versus those who did not. However, students who trained in office settings were noted to have higher JSE scores at the three-month follow-up survey, students who worked in hospital settings had higher JSE scores at the completion of the clerkship, and student who worked in assisted living facilities had higher GAS scores at the completion of the clerkship.

Conclusions

Teaching students ways to improve empathy can be challenging. The setting in which a student trains may be an area of focus for improving empathy among trainees and should be researched further.

Motivation to Impact: Medical Student Volunteerism in the COVID 19 Pandemic

OBJECTIVE

Volunteerism represents an important mechanism to promote resilience, empathy, and general well-being in medical students, a group that stands to benefit. Medical students report feelings of fatigue, burnout, exhaustion, and stress that correlates with poor academic performance, and significant decline in empathy over the 3^rd year of both MD and DO programs. Volunteer motivations have been shown to mediate participant well-being. The relationship between medical student volunteer motivations and specific outcomes during the COVID-19 pandemic has not been addressed.

METHODS

We characterized features of medical student volunteers during the COVID-19 pandemic in 2020, including volunteering motivation using the Volunteer Functions Inventory, the types of activities in which they participated, and the physical, psychosocial, and emotional outcomes they experienced following volunteering.

RESULTS

Altruistic and humanitarian values-centric motivation predicts positive volunteering outcomes including increased resilience, ability to deal with disappointment and loss, and ability to cope with the COVID-19 pandemic. Values-centric motivation also increases volunteer empathy independent of educational stage. Values-centric participants were more likely to select volunteering activities with patient contact, which promotes student empathy and resilience. Conversely, career-centric motivation does not predict positive outcomes. These students are more likely to engage in research-oriented activities.

CONCLUSIONS

The efficacy of integrating volunteerism into medical school curricula may be limited by professional pressure that manifests as career-oriented motivation. We propose that practical integration should promote altruistic and humanitarian values-centric participant orientation to the volunteering process, which is associated with enhanced recruitment, preservation of empathy, and additional positive volunteering outcomes of interest.

Empathy development and volunteering for undergraduate healthcare students: A scoping review

OBJECTIVES

Empathy in healthcare benefits patients and healthcare providers. However, empathy decline is a recent trend within healthcare education. There is a paucity of literature that investigates the impact of volunteering on the empathy levels of undergraduate healthcare students. This scoping review explores the literature regarding empathy and volunteering for healthcare students.

DESIGN

The Joanna Briggs Institute methodology for scoping reviews guided this study.

DATA SOURCES

The electronic databases MEDLINE, CINAHL, ProQuest, JBI, Cochrane, PubMed, PsychInfo, and PsychNurses were searched from January 2001 to August 2021. The original search was developed in MEDLINE and then adapted to the other databases.

REVIEW METHODS

This scoping review used the Joanna Briggs Institute scoping review methodology. The search retrieved a total of 310 articles. Following deduplication, 271 articles were reviewed by title and abstract. Thirty articles were reviewed in full text with twelve articles meeting the criteria for inclusion. Included studies were assessed using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

Five qualitative, four quantitative and three mixed method studies were included. A variety of volunteering interventions for undergraduate healthcare students were identified from countries including the United States of America, Singapore, Australia, and Brazil. Thematic analysis identified that volunteer undergraduate healthcare students practiced and developed empathy, and experienced professional and personal development.

CONCLUSIONS

Volunteering interventions were primarily in a service-learning modality within community health and palliative healthcare settings. Inconsistencies exist in empathy definitions and empirical empathy measurement. There is a need for more research that explores empathy development through volunteer activities in acute care settings.

Impact of Medical Student Participation in Student-Run Clinics on Education, Residency Selection, and Patient Care: A Review of Selected Articles

Student-run clinics (SRCs) are becoming increasingly popular at medical schools in the United States. These clinics have provided a variety of benefits, including serving disadvantaged populations and providing early clinical exposure for students. There has been no consensus on the impact of SRCs on medical education, specialty selection, and patient care. This review provides a thorough overview of student and patient outcomes as a function of medical students volunteering at SRCs. We queried PubMed for original literature published in English between the years 2000 and 2020. Inclusion criteria included primary research articles evaluating the impact of medical student participation in SRCs on education, specialty selection, and patient care. All articles included in the final review were agreed upon by three reviewers, and the pertinent data were extracted. Of 10,200 initial search results, seven papers were included in this review. These included two studies evaluating medical education, five studies evaluating residency selection, and three studies analyzing patient care. Three studies were included in multiple evaluations. The relationship between volunteering at SRCs and academic performance is unclear. Clinic volunteers had increased retention of empathy compared to non-volunteers. Additionally, clinic volunteers provided satisfactory care as determined by patient-reported outcomes, and were not more likely to pursue primary care specialties. As SRCs are increasing in number, research into the impact on medical students and patients is necessary to understand how these clinics may affect the field of health care. It is important to further evaluate how medical student involvement in SRCs can further improve patient care and outcomes.

Parental care and depressive symptoms among Chinese medical students: roles of empathy and gender

BACKGROUND

Medical students in China who face the dual pressure of study and employment tend to experience subclinical depressive symptoms. Parental care plays an important direct and indirect role in the psychological development of medical students, and the extent and mechanism of this role urgently need to be studied and discussed.

METHODS

After simple random sampling and screening of valid questionnaires, data from a total of 924 people were used. The participants completed the parental bonding instrument, self-rating depression scale, Chinese version of the Jefferson empathy scale-medical student edition and self-rating anxiety scale to evaluate parental care, empathy, depressive symptoms and anxiety. The data were statistically processed using a descriptive analysis, correlation analysis and test of moderated mediation.

RESULTS

Maternal care had a significant negative predictive effect on depressive symptoms among medical students. Strong maternal care can reduce the occurrence of depressive symptoms in medical students. Empathy played a positive mediating role such that both types of empathy could alleviate the effect of weak maternal care on the depressive symptoms of medical students. However, neither cognitive empathy nor affective empathy played a mediating role in the relationship between paternal care and depressive symptoms. Nevertheless, the relationship between maternal care and empathy was moderated by the medical students' gender.

CONCLUSIONS

The effect of this relationship on female medical students deserves special attention. The results of this study provide a reference and basis for the adjustment of medical education. This study could also help in the design of effective psychological intervention measures to reduce the degree of depressive symptoms and enhance personal empathy.

Student-Run Free Clinics Stand at a Critical Junction Between Undergraduate Medical Education, Clinical Care, and Advocacy

Student-run free clinics (SRFCs) act as primary care providers that bring health care to populations in need and are an important source of undergraduate medical education (UME), guiding trainees through the art of history taking and physical examination. However, they are also social justice and advocacy initiatives-addressing disparity in access to care and educating medical trainees with firsthand exposure to socioeconomic determinants of health as well as language and medical illiteracy barriers. Here, the authors review academic literature examining the impact of SRFCs in their 3 roles: as medical care providers, as components of medical education, and as advocacy organizations. Based on the evidence of that literature and decades of direct SRFC leadership experience, the authors make the case that SRFCs are an undersupported means by which UME institutions contribute to correcting health care disparities and to serving social justice reform.

Service learning and the medical student affective domain

BACKGROUND

The Association of American Medical College (AAMC) requires all students to demonstrate four core attributes: knowledge, skills, altruism and dutifulness. A formal service-learning curriculum may serve to explicitly foster altruism and dutifulness in the affective domain of Bloom's taxonomy as well as proactively improve student well-being.

APPROACH

All Harvard Medical School students enrolled in the Principal Clinical Experience (PCE) programme in the 2018-2019 academic year at Brigham and Women's Hospital were excused from clerkship responsibilities and given the opportunity to participate in a half-day team-based community-service intervention at a not-for-profit organisation in Boston, MA. Following the service-learning initiative, we examined student compassion, civic responsibility, well-being and team cooperativeness using validated survey questions, supplemented by free-text feedback.

EVALUATION

Forty-five of the 55 PCE students (82%) attended the outing. Overall, 68% of students found the outing to be valuable and 23% somewhat valuable. On a scale of 0-20, students reported very high self-perception of compassion (mean = 19.9), civic responsibility (mean = 19.7) and team development and composition (mean = 19.1), after the event. Students reported lower perceptions of personal well-being (mean = 17.5), but emotional wellness was the most frequently mentioned theme in open response.

IMPLICATIONS

Incorporation of a team-based service-learning activity contributes to the students' community understanding, empathy and class team building. Utilisation of a published framework in the development of this initiative likely contributed to its success. Given our findings, we plan further expansion of this service learning longitudinally through the 4-year curriculum to potentially strengthen the affective domain for students further.

Normalizing Service Learning in Medical Education to Sustain Medical Student-Led Initiatives

Medical students demonstrate their passion for participating in and improving health care both within and outside the classroom. As the COVID-19 pandemic swept across the world, medical students in the United States engaged in student-led service-learning initiatives to contribute to medicine and their local communities, including collecting and distributing personal protective equipment, creating and translating pandemic-related educational materials, and providing childcare for frontline workers. Their impact was recognized and appreciated. Service learning is an education method that incorporates community outreach with didactic coursework and student reflection. In this commentary, the authors argue for including service learning as a required component in the medical school curriculum to provide students with the tools and support to be advocates and leaders within society, as no such curriculum currently exists. The authors also discuss the history of medical student-led service-learning efforts through to the present day, barriers to implementing and sustaining student-led service-learning initiatives, and solutions to prepare students for service-learning initiatives.

A Systematic Review of Educational Interventions and Their Impact on Empathy and Compassion of Undergraduate Medical Students

Introduction: A compassionate and patient-centered care leads to improved clinical outcomes. Promoting empathy and compassion of medical students is a forerunner of their well-being, emotional stability, and a patient-centered care. However, there is slender evidence about best educational interventions that can inculcate empathy and compassion skills. Our objective was to conduct a systematic review of research evaluating the associations between spectrum, effectiveness, frequency of teaching modalities and their outcomes on compassion and empathy to highlight best practices.

Methods: We searched the Web of Science, PubMed, Scopus, and EBSCO Host on 22nd July 2020. We adapted our search strategy from a previously published systematic review on education for compassion and empathy. Selected studies were required to have used unique educational interventions for promoting empathy and compassion of medical students. The research questions were based on Participants (medical students), Intervention (empathy and/or compassion related teaching), Comparison, and Outcome.

Results: We analyzed 24 articles from the initial yield of 2,861. Twenty-two were quantitative studies with a mean of 12.8 on MERSQI. Twelve were randomized controlled trials while 5 measured outcomes with single group pre- and post-tests. There was no association found between duration, frequency and complexity of an educational intervention and its effectiveness. Twenty used multimodality curricula, and of those 18 reported statistically significant positive improvement in empathy, while 3 of 4 single modality were effective. Only three studies looked for long-term effects of educational interventions. Fourteen studies evaluated Kirkpatrick's level one (self-reported knowledge), 2 level three (behavior), and 6 level four (patient outcomes). We identified six major educational constructs of teaching empathy and compassion; communication, mindfulness, early clinical exposure, technology-enhanced learning, comics and arts and culture.

Discussion: Our review couldn't identify a standard teaching construct in place and highlighted that different teaching tools carry similar impact in promoting compassion and empathy and a sustainable program rather than a single training activity is essential.

Does Global Surgery Interest Influence the Choice of Surgical Residency Program?

OBJECTIVE

Medical students actively seek global health opportunities. Surgical residents also show great enthusiasm for international missions, rotations and global surgery. Unfortunately, only 18% to 34% of all surgery residency programs offer such international opportunities. We surveyed fourth year medical students applying for surgery residency to determine if international surgery opportunities offered by a program would influence their match rank list.

DESIGN

A 20 question survey was given to interviewees at our surgery residency program. Survey was optional and anonymous. We queried prior volunteerism, interest in global surgery and importance of international opportunities offered during residency.

SETTING

Hackensack University Medical Center, Hackensack New Jersey PARTICIPANTS: All candidates interviewing for general surgery residency at Hackensack University Medical Center from October 2019 to January 2020.

RESULTS

A total of 97 fourth year medical students interviewed, with a 66% response rate to the survey. Mean age was 27 years. 92% of students had volunteered during college and/or medical school. 41% of students had volunteered internationally. Majority of students were interested in a surgery residency program offering international opportunity. 78% of students planned to volunteer internationally after residency, and two-thirds planned to include global surgery in future career. Half of the students reported they would rank a residency program higher if it offered an international opportunity. Students who were immigrants were significantly more likely to rank a program higher in the match if an international opportunity was offered, compared to students born in the US (p < 0.05).

CONCLUSIONS

There is great interest in global surgery and international volunteer opportunities amongst fourth year medical students who apply for surgery residency. The majority of applicants have prior volunteer experience either locally or abroad. Majority of students plan to volunteer internationally after residency and are interested in academic global surgery careers. Students will rank surgery residency programs that offer international opportunities higher in the match.

Student-Led Clinics in Aotearoa New Zealand: A Scoping Review with Stakeholder Consultation

Background

Student-led clinics have gained increasing attention as a mechanism for students across various health professions to gain authentic interprofessional clinical placement experience during their educational programme.

Purpose

This scoping review is designed to identify and describe experiences relating to student-led clinics in Aotearoa New Zealand.

Methods

The review involved five key steps: 1) identifying the research question; 2) identifying relevant studies; 3) study selection; 4) charting the data; and 5) collating, summarising and reporting the results.

Discussion

Student-led health clinics present invaluable educational opportunities for authentic collaborative practice and capacity to improve population health and well-being, especially in marginalised and disadvantaged communities. Clinic establishment and operation require consideration of a complex set of factors.

Conclusion

Community consultation (including with Indigenous populations) should precede establishment of clinics. There is scope for more reporting and objective evaluation to ensure best practice is being determined, developed, and achieved.

Building Longitudinal Relationships Into a Traditional Block Clerkship Model: A Mixed-Methods Study

PURPOSE

The authors describe the implementation of the novel Longitudinal Clinical Experiences with Patients (LCEP) curriculum, designed to integrate continuity and longitudinal patient relationships into a traditional block clerkship (BC), and present a mixed-methods analysis evaluating program effectiveness to assess its feasibility, value, and impact.

METHOD

This was a mixed-methods study of 54 Harvard Medical School students who participated in the LCEP during their core clerkship (third) year during the 2013-2014 academic year. Fifty-two students responded to an electronic survey about the patients they followed during the LCEP. Forty-two students completed confidential live interviews. Unique groups of 13-15 students were interviewed at 3 times during the year to assess students' perceptions of the LCEP over time. The data were analyzed using a content analysis framework.

RESULTS

On average, students followed 3.3 LCEP patients over the clerkship year. Ninety-four percent (n = 49/52) of students were able to follow 2 or more patients longitudinally. Most students met their longitudinal patient in the inpatient setting (71%, n = 37/52). Subsequent encounters were most often in the ambulatory setting. Students described scheduling logistics as key to the success or failure of the program. Many students described the challenges of competing priorities between their BC responsibilities and longitudinal opportunities. Students found the LCEP deepened their understanding of the patient experience, the health care system, and disease progression. Over the course of an academic year, an increased proportion of students (60%) highlighted understanding the patient experience as a core value obtained through the LCEP.

CONCLUSIONS

The LCEP was feasible and proved successful in promoting longitudinal patient relationships within a traditional BC model. Prioritizing the depth of experience with a smaller number of patients may reduce the barriers described by students. The results suggest that such a hybrid program promotes patient-centeredness.

Examining the Educational Value of Student-Run Clinics for Health Care Students

PURPOSE

Student-run clinics (SRCs) are increasingly recognized as an educational experience in many health professions' curricula. Several benefits have been documented, including students with SRC experience using patient-centered approaches to care, showing interest in working with marginalized populations, and more fully appreciating the care provided by interprofessional teams. Yet, few studies have explored student experiences within SRCs or examined how these experiences affect and shape these documented attitudes. This study explored the experiences of students at an SRC and the effect of these experiences on their learnings.

METHOD

From November 2016 to July 2017, 23 students in the Community Health Initiative by University Students SRC at the University of British Columbia participated in 2 focus group interviews: the first after their first clinic day and the second on their final clinic day. Open- and closed-ended questions were used to explore participants' learnings from the SRC. Using a grounded theory approach, the authors iteratively analyzed the transcribed interviews, adjusting questions for subsequent focus groups as new themes evolved. Three investigators each separately coded the data; the full team then collectively consolidated the themes and developed explanatory models for each theme.

RESULTS

Two themes were identified from the focus group input: (1) through managing real, complex patients-in situations unlike those offered in classroom and case-based learning environments-students gained insights into the intricacies of incorporating the patient's perspective into their definition and management of the patient's problem, and (2) by working as a team instead of focusing on delineating scopes of practice, students gained a meaningful understanding of the roles of practitioners from other health professions.

CONCLUSIONS

This study provides insights into the unique opportunities SRCs offer health care students early in their training, enabling them to develop a richer understanding and appreciation of holistic and interprofessional approaches to patient care.

Impact of Student-Run Clinics on Students' Attitudes Toward People Experiencing Homelessness

Introduction

Student-run clinics can supplement medical education by exposing students to diverse clinical scenarios and collaborating with underresourced populations. We examined the impact of volunteering at THRIVE, a student-run bridge clinic located within sheltered housing for individuals with substance use disorder, on students' attitudes toward people experiencing homelessness (PEH).

Methods

This cohort study analyzed pre- and postsurvey matched responses from nonvolunteer and volunteer first-year medical students utilizing the Health Professional Attitudes Towards the Homeless (HPATHI) tool, totaled into three subcategories: Cynicism, Social Advocacy, and Personal Advocacy. We evaluated the association between change in scores and volunteering utilizing Student t tests and adjusting for participant characteristics using multivariable regression analysis.

Results

We received 106 responses (53% response rate); 58 students (55%) volunteered at the clinic and were mostly female (62%), White (52%), and had previous experience working with PEH (71%). The mean change in Personal Advocacy scores was higher for volunteers compared to nonvolunteers, even when adjusting for respondent characteristics (P=.02). Additionally, students who held a prior advanced degree and/or current enrollment in the master of bioethics program (Higher Education Students) had a positive association with change in Personal Advocacy scores (P=.02).

Conclusion

Volunteering at the THRIVE Clinic appears to impact the Personal Advocacy scores of medical students. This suggests that interacting with PEH early in students' career may be associated with a commitment to working with this population. However, our study has multiple limitations, including self-selection bias, limited sample size, and unclear permanence of students' attitudes over time. Further studies of this cohort could help clarify the significance and permanence of volunteering in student-run clinics.

Establishing a student-run free clinic in a major city in Northern Europe: a 1-year experience from Hamburg, Germany

BACKGROUND

Student-Run Free Clinics (SRFCs) have been an integral part of US medical schools since the 1960s and provide health care to underserved populations. In 2018, we established an SRFC in Hamburg, Germany, a major city in Northern Europe. The aim of this study was to describe the central problems and to investigate the usefulness of an SRFC in a country with free access to medical care, such as Germany.

METHODS

All consecutive patients treated at the SRFC Hamburg between February 2018 and March 2019 that consented to this study were analyzed regarding clinical characteristics, diagnosis, readmission rate and country of origin.

RESULTS

Between February 2018 and March 2019, 229 patients were treated at the SRFC in Hamburg. The patients came from 33 different countries with a majority (n = 206, 90%) from countries inside the European Union. The most common reasons for visiting the SRFC were infections (23.2%), acute or chronic wounds (13.5%) and fractures (6.3%).

CONCLUSION

Our multicultural patients suffer mainly from infections and traumatological and dermatological diseases. We find similarities to published Canadian SRFC patient cohorts but differences in diseases and treatment modalities compared to US SRFCs. Importantly, we demonstrate the relevance and necessity of the SRFC in a major city in Northern Europe.

Student-Led Mobile Health Clinic: Patients Served and Learning Experience

PURPOSE

Community medicine curriculum prepares physician assistant (PA) students to provide services to vulnerable and underserved populations. This article describes a service-learning model that uses a mobile health clinic (MHC) experience as part of the community medicine rotation. It provides an overview of the clinic's operation, patient documentation and characteristics, and student learning experiences.

METHODS

Students collected demographic information on patients who visited the MHC during January through December 2017. The students summarized patient demographics and reflected on their experiences in a report.

RESULTS

Two main outcomes are discussed: characteristics of the MHC patients and student observations about their experiences. In 2017, 113 students rotated through the MHC and recorded 813 patient encounters. The largest proportions of patients reported living on the street or in a shelter (71%) and were older than 56 years (40%), males (74%), Caucasian (43%), single (65%), nonveterans (77%), and high school graduates (41%). The top 5 reasons for visits were preventive care, cognitive/functional impairment, cardiometabolic disorders, skin issues, and respiratory illness. The MHC experience and process of recording and analyzing demographic data contributed to students' data management and analytical skills. The students identified problems of recordkeeping and their implications for patient care, gained a greater understanding of medical needs and complexities of treating the homeless, and provided suggestions for improving quality and efficiency of care.

CONCLUSIONS

The MHC service-learning model provides diverse, meaningful experiences for students. Our findings benefit PA programs aiming to expand and strengthen their community medicine curriculum.

Attitudes and Practices of Dental Students in Providing Oral Health-Care Services to Underserved Rural Patients Attending Dental Institutions of Telangana, India

Introduction:

Attitude is a relatively enduring organization of beliefs around an object, subject, or concept, which predisposes one to respond in some preferential manner. It decides one’s action. Dental students frequently come across underserved rural population and must have good attitudes toward them, so that the care delivered to them will be optimum.

Aim:

To assess the attitudes and practices of dental students in providing oral health-care services to underserved rural patients.

Materials and Methods:

A cross-sectional study was conducted among final-year Bachelor of Dental Surgery (BDS) students, interns, and postgraduate students who are involved in providing dental care in dental institutions of Telangana State, India. A 15-item, self-structured, pretested questionnaire was administered. Descriptive statistics were calculated using the Statistical Package for the Social Sciences (SPSS) software, version 20.0. Attitudes and practices of undergraduates and postgraduates were compared using paired t-test.

Results:

A total of 574 students participated in the study. Approximately 73.3% of the dental students agreed that they personally want to be involved in providing oral health care for the underserved and 27.1% students disagreed that underserved patients are subjects on whom they can train and expertise. Approximately 56.62% of dental students often asked patients about the expenses they bear for attending a single dental visit and 53.48% tried to minimize the number of appointments required for the patients. No significant difference was observed in attitudes between undergraduates and postgraduates.

Conclusion:

Dental students had moderate attitude toward underserved patients but this was not reflected in their practices.

Civic-Mindedness Sustains Empathy in a Cohort of Physical Therapy Students: A Pilot Cohort Study

Background:

Empathy is critical to patient-centered care and thus is a valued trait in graduate health-care students. The relationship between empathy and civic-mindedness in health professions has not previously been explored.

Objectives:

(a) To determine whether significant differences occurred on the Jefferson Scale for Empathy–Health Professions Student Version (JSE-HPS) and Civic-Minded Professional scale (CMP) and its subscales across the curriculum, (b) to explore a potential relationship between civic-mindedness and empathy in a cohort of graduate physical therapy (PT) students at regular intervals, and (c) to explore the predictive ability of civic-mindedness on empathy scores.

Methods:

This study was a convenience sample of a cohort of 48 PT students who completed both the JSE-HPS and the CMP at 4 points of a service-learning intensive curriculum. Statistical analysis included descriptive statistics, a Friedman’s analysis of variance with Wilcoxon signed-ranks post hoc testing, and Spearman correlations with stepwise linear regressions.

Results:

Statistically significant differences were not found for the JSE-HPS. Civic-Minded Professional scores increased across the curriculum. The JSE-HPS, the CMP, and various CMP subscales were significantly correlated. The JSE-HPS pretest scores were predictive of the year 1 and 2 posttest JSE-HPS scores.

Conclusion:

This study’s findings indicate that service-learning and the resulting development of civic-mindedness supports empathy. Programs could use JSE-HPS pretests to identify individual graduate students need for empathy mentorship upon program entrance or as one admission criterion.

Increasing Medical Trainees' Empathy Through Volunteerism and Mentorship

BACKGROUND

Within medical education, there have been recent calls for increased understanding and exposure to poverty to increase trainees' empathy toward the underserved. Students participating in Michigan Cardiovascular Outcomes Research and Reporting Program research program volunteered at World Medical Relief (WMR) in Detroit, Michigan, a nonprofit organization which recycles medical equipment for developing countries and within greater Detroit. Participants' perceptions of the underserved were measured before and after the experience.

METHODS

Preliminary questionnaires were given to participants prior to and after exposures at WMR. Questionnaires examined participants' attitudes toward the underserved, knowledge of medical supply reuse, and their perceived ability to impact change. P values of <.025 were considered significant.

RESULTS

A total of 39 participants completed the survey, 77% previously volunteered, 33% had volunteered internationally. Participants were >4× more likely than previously to have knowledge of the variety of recycled medical supplies at WMR. Prior to volunteering, 48.7% of participants gave little thought to how excess medical supplies could be collected versus 0% after exposure. Participants were 1.5× more likely to agree that the experience was enhanced working with their peers and 2.7× more likely to consider starting their own organization/intervention for medical supply donations. Those participants that never previously volunteered were 1.3× more likely to do so with encouragement from a mentor.

CONCLUSIONS

Encouraging exposure to such service programs resulted in enhanced knowledge of community resources and increased motivation to participate in outreach and belief of individual responsibility to care for the underserved. Incorporating volunteerism into traditional education programs offers the opportunity to build awareness and interest in students reaching out to the underserved.