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  • Page 1 Evaluation of the Student Volunteer Experience at UR Well Student Outreach **213** Block 2, 2007 ABSTRACT UR Well Student Outreach is a student run free clinic designed to benefit both the uninsured it served and the volunteer students. In 2003, volunteer goals were decided. The purpose of this project was to design and implement an evaluation of the student volunteer experience at UR Well. The evaluation was designed with the input of the UR Well Steering Committee and Adrienne Morgan. Key Informant Interviews were completed and a Questionnaire was started. Interviews revealed intended goals are reached, however not equally in all volunteer positions. Suggestions for future direction of the clinic were made. Further development of the questionnaire will allow evaluation to be sustainable. BACKGROUND OF PROBLEM The number of uninsured Americans has been steadily increasing. According to the US Census Bureau, in 2001, an estimated 41 million were uninsured. In 2006, this number had risen to nearly
  • Page 2 47 million people.1 While precise numbers are debated, the consistent increase from year to year is not. 2 Contrary to popular perception, the majority of uninsured in America are employed (70.7%), with an additional 7.2% connected to the work force. Overall, more than 80% of individuals without health insurance are part of families where at least one member works full- or part-time. Nationally, three key reasons uninsured yet employed people cite for their lack of insurance are: no health insurance benefits offered at the job, inability to cover the cost of premiums, and temporary job loss. 2 Uninsured people are unable to access the same level of care as their insured counterparts. They are more likely to delay seeking medical care, forego medical care for potentially serious symptoms, have poorer treatment of chronic diseases and receive fewer screening services [see figure 2].2, 3 Uninsured individuals are 4 times more likely to not have a regular care facility and 4 times more likely to use emergency room services than people with insurance. 2 Compared to only 1 in 14 insured adults, 2 in 5 uninsured adults reported in a recent survey that they could not see a physician when they wanted to in the last year secondary to cost. This same survey reported that uninsured adults with high-risk conditions such as smoking, obesity, hypertension, and diabetes were less than half as likely to access routine medical care than their insured counterparts [see figure 4].4
  • Page 3 Figure 2. Proportions of Adults Who Did Not Receive Appropriate Preventive Services 100 Uninsured ≥1y Insured 90 80 70 60 Percentage 50 40 30 20 10 0 Ma Pa Si Bl Ch W Sm HI m p gm oo ol e e ig ok V mo Sm oi d dP ste ht i ng gr ea os res ro Lo ap r co su l ss hy py re S creening Source: Ayanian, J. Z. et al. "Unm et Health Needs of Uninsured Adults in the United States." JAMA, 284(16):2061-2069. October 25, 2000. Figure 4. Proportions of High-Risk Adults Who Did Not Have a Routine Checkup by a Physician During the Rrior 2 years 60 Uninsured ≥1y Insured 50 40 30 20 10 0 M S O H E B A
  • Page 4 Limited access to care in turn leads to poorer outcomes. Working-age Americans without health insurance are more likely to be diagnosed late with particularly damaging diseases such as cancer3 or diabetes5, more likely to be hospitalized due to lack of early or preventative outpatient treatment, receive too little medical care and receive it too late 2, 5, 6, be sicker and die sooner, and receive poorer care when they are in the hospital even for acute situations.3 The overarching goals of Healthy People 2010 are to increase quality and years of healthy life and to eliminate health disparities.7 Lack of insurance clearly hinders the achievement of both of these goals. In response to the issues facing the uninsured, free clinics have provided a safety-net of health care. Since the 1950’s free clinics have served as private, nonprofit corporations that provide primary and specialty care, prescription medications, and ancillary medical services. Services are provided at little or no charge and delivered almost exclusively by volunteer licensed health care professionals. There are over 350 registered free clinics in the United States and most of these have started in the last two decades.8 Free clinics have been shown to reduce the preventable hospitalization rate in the area that they serve.9 A 2001 survey of 281 clinics showed that 75% of clinics targeted uninsured patients. Fifty-five percent had an income based eligibility criteria of 200% Federal poverty level or less. Clinics provided a mean of 5,989 patient visits per year and 11,202 prescriptions per year to 2,311 patients.10 Because of small operating budgets, clinics rely heavily on the hours put in by volunteers.11 The clinics surveyed were staffed on average by 156.7 volunteers and 6.9 paid
  • Page 5 employees per clinic. In the course of one year, these surveyed clinics provided care to 650,000 patients.10 This number, however still leaves over 40 million without insurance and not covered by these clinics. With the number of uninsured people rising, and no systemic cure in sight, it is essential that future doctors be trained to provide care for this population. A 2003 study looking at what influences students to do future work with underserved populations showed that the biggest predictor was whether the student came from a medically underserved area. Less significant, but not fixed was whether the student had exposure to underserved populations either prior to or during medical training.12 In addition, working with medically underserved populations during training has been shown to reinforce ideas of non-judgmental provision of care, and increased professional satisfaction.13 Free clinics not only provide this exposure, but have other benefits as well. Students are able to interact with patients and see them holistically rather than objectively.14 Evaluation of volunteer experiences at the Houston Outreach Medicine Education and Social Services (HOMES) clinic showed that students found increased compassion and empathy, social awareness, team work and confidence building.15 Over 30 Medical Schools across the country have developed their own free clinics to both address the needs of the uninsured or homeless and to provide an enhanced educational experience for the students. 15-19 Most of these clinics operate out of donated spaces that are already accessing homeless and underserved populations such as shelters, missions and churches.13, 20
  • Page 6 As continued student involvement in these clinics is integral to their success and sustainability, it is critical that the students that staff these clinics benefit as well as the patients they see. Evaluations of student experiences at free clinics have been performed, but few are available in the literature. The University of Washington’s Students in the Community (SITC) clinic discussed using a previously validated measure of attitudes toward homeless.21 The University of San Diego also discussed evaluating student experiences, but has yet to report the results or publish the evaluation.18 Contact with other student-run free clinics around the country reveals other groups are interested in evaluating their own volunteer programs, but few evaluation protocols already in place. BACKGROUND OF COMMUNITY New York, Monroe County, and the city of Rochester are not immune to the issue of community members lacking insurance. New York, in particular, has 2.7 million uninsured residents (14.2%) according to 2006 US Census estimates.1 With 10% of people aged 18-64 of Monroe County uninsured, it is better than many places in the country. When converting this percentage to numbers, however, this comes to 45,000 individuals in the Monroe County community alone. Like the rest of the nation, the majority (67%) of uninsured individuals are employed. The same reasons for lacking insurance were cited in the Monroe County community as nationally. Likewise the same pattern of increased hospitalizations, decreased access to preventative services, and decreased access to medical care all together exists for Monroe County. In Monroe County, nearly one in four uninsured individuals reported finding it “extremely” or “very difficult” to get medical care when needed compared to 2% of the insured. When accessing care, people without insurance had a greater likelihood of using the emergency room (37%) as compared to the insured (16%).
  • Page 7 Worse yet, 43% of uninsured reported postponing needed medical care altogether. In addition, more than three quarters of the uninsured reported being unable fill a prescription because of cost, as compared to about one quarter of the insured.22 University of Rochester School of Medicine and Dentistry students have a strong history of involvement in the Rochester community. Over the last sixteen years, the community outreach program has placed over 1200 students at various agencies throughout the Rochester, providing free school physicals, supporting patients in the hospital, tutoring for inner-city school children, among other activities. In 2003, the idea was born of expanding these opportunities and addressing the needs of the uninsured in our own community in the form of a student-run free clinic. A core group of students under the direction of Adrienne Morgan attended conferences, visited other free health clinics, researched clinic staffing structures, and surveyed the Rochester community to better understand what needs were not being addressed. The Southwest Area (SRA) of Rochester was found to have particular need. In 2000, this area was home to 19,774 individuals. The median income of homes in this area was $20,582 compared to $27,123 in the city as a whole and $44,891 in the county. Thirty-three percent of households were mothers caring for children alone compared with 23% in the city. Although there is no specific data for the SRA, based on the median income for the area, one could classify many in SRA as "working poor." This population would benefit from the services of a free clinic that was open during traditionally non-working hours. With the gathered information and experiences, a model and
  • Page 8 plan for Rochester’s first student-run free clinic operating in this neighborhood of Rochester was developed. 23 The core group expanded in the winter of 2003 to form a steering committee consisting of several teams: clinical coordinator, administrative coordinator, student volunteer coordinator, physician volunteer coordinator, referrals, pharmacy, financial director, clinic director, statistics and public relations. In spring 2004, the steering committee partnered with St. Joseph’s Neighborhood Center, a health center operating near the Southwest neighborhood, to use their facilities on Tuesday nights. The clinic opened its doors on September 14th, 2004 with the mission of “providing free, high quality health maintenance and preventive services to local uninsured families and individuals in an effort to foster the health of the Rochester community, while promoting the spirit of education, social justice and collaboration.” 23 While the steering committee still organizes and guides the clinic, it is the student and physician volunteers that come each week that allow the clinic to run. The volunteer model of the clinic [see figure 1] is based on the New York City Free Clinic implemented by New York University School of Medicine.19 It consists of a front desk team who checks the patient in and out, a medical assistant who takes vital signs and puts the patient in the room, a health team of a second year medical student and a fourth year medical student who sees the patient, an administrative coordinator who works at the front desk to manage logistics and a clinical coordinator who works with the health teams to answer questions and facilitate the evening. The health teams report to a volunteer physician and discuss the plan for the patient. Referrals made on the clinic night are followed up by a separate volunteer who comes in during the week. The model was
  • Page 9 chosen to provide the best educational experience to the volunteers while still providing high quality health care to the patient. Figure 111 Clinic Logistics Front Desk Two 1st Year Students Waiting Area Health Education & Statistics Administrative Coordinator One 2nd year student answers questions from the front desk, draws labs, and oversees Medical Assistant management of medical records One 1st Year Student and information transfer Vitals & Chief Complaint Clinical Coordinator One 4th year student who answers Team A Team B Team C questions from the health teams One 3rd or 4 Year Student One 3rd or 4 Year Student One 3rd or 4 Year Student or the physician, draws labs, One 2nd Year Student One 2nd Year Student One 2nd Year Student assists with referrals, and provides continuity of care Volunteer Physician One licensed doctor confirms exam findings and collaborates with students concerning: Medications Laboratory Work Specialty Referrals Diagnostic Tests Under this model, the following goals for the student volunteer experience were laid out. • Opportunity for hands-on medical education and knowledge application of principles and skills learned throughout the medical curriculum • Improved awareness of the insurance disparity as a public problem • Opportunity to apply human faces to the staggering numbers of uninsured persons
  • Page 10 • Opportunity to appreciate the importance of cost effective medical decisions and treatment plans • Exposure to an inner-city primary care health center • Inspire future physicians to consider entering a career with significant attention to the care of medically underserved populations • Provide a unique and important outlet to students seeking an opportunity for direct medical service to an underserved population • Maintain medical student interest in social justice, primary care, and the underserved • Exposure to the financial and human management of medical services • Experience in teaching In a clinic that would be sustainable across the years.23 As discussed above, student volunteers are the substance of the clinic and ensuring and enriching experience is vital to the continuation and growth of the clinic. The clinic thus far has been very successful and student interest continues to be high. Students are recruited as first years at the Community Involvement Fair at the beginning of the first year as well as with informational meetings. Students are recruited via email, as well. Current interest has exceeded the number of volunteer positions available with 42 interested first years in a lottery for only 12 slots. Maintaining this interest to staff free clinics over time can be challenging.24 Discussions of expanding the clinic to include an additional night or provide other services are on the table. 25 This, naturally, would require more involvement by the student volunteers. As UR Well Student Outreach looks to the future of expanding the hours of the clinic and the resources that clinic offers, it is essential that the experiences of our volunteers are understood. The evaluations previously performed and documented as discussed above do not pertain to our population of
  • Page 11 patients and our model of healthcare. Thus, to evaluate our system, there is a need to develop a tool to do so. PROJECT DESCRIPTION AND METHODS The purpose of this project was to develop and implement a program evaluation of the student volunteer experience at UR Well, to determine whether or not the students are reaching the intended goals, what other benefits they may be getting, and what improvements can be made. The specific type of evaluation depends on the framework used to define the program. If considering UR Well as a whole, the student volunteer portion of the project is part of the process and this could be considered a process evaluation. If looking at specifically the student volunteer aspect of the program, this is an evaluation of the impact of the program on the students. The framework for the design of this program evaluation was derived from the Centers for Disease Control Evaluation Working Group. For any program evaluation designed, for it to adhere to the standards of utility, feasibility, propriety, and accuracy, following the steps laid out in figure 3 are recommended.26 Figure 326
  • Page 12 This evaluation was developed and implemented through the basic steps of Engaging the Stakeholders, Describing the Program, Focus the Evaluation Design, Gather Credible Evidence, Justify Conclusions, Ensure Use and Lessons Learned. This section will address the first 5 of these steps. Engaging the stakeholders is necessary in order to ensure that results of the evaluation will be useful and pertinent to the program being evaluated. The stakeholders in this case are the steering committee and the director of the clinic who guide the future directions of the clinic. They were notified of this project at its inception and asked to give input as to what should be included in the evaluation. Other stakeholders are the student-run clinics across the country that may also be either looking for a method to evaluate their programs or may have input as to their own experiences with evaluation.
  • Page 13 Describing the program delineates the strategies and goals of the clinic and is the foundation for the content of the evaluation itself. This aspect of evaluation development was completed by researching the history and initial proposal of UR Well Student Outreach as detailed in the community background section. In the design of the evaluation, six aspects should be considered—purpose, users, uses, methods, questions, agreements. The purpose of this evaluation was two-fold—to assess the effects of the volunteer program on the volunteers, and to determine if there are areas of the program that need change. The users of the evaluation are the UR Well Student Outreach Steering Committee, and the faculty director of the project. The evaluation will be used to optimize the student volunteer experience. Due to time constraints, the initial evaluation was done using key informant interviews with concurrent development of a questionnaire that could be more widely distributed. The questions for both the key informant interviews [Appendix A] and the questionnaire [Appendix B] were developed using the stated goals for volunteers as the backbone. These were both sent to the stakeholders for their input for content and readability. The final question sets were piloted (for key informant interviews) and will be pre-tested and piloted (for questionnaire) prior to administration. Gathering credible evidence is essential to the use of the results of the evaluation being created. Indicators, sources, quality, quantity, and logistics are all aspects of evidence gathering. The indicators of this evaluation were the goals stated for volunteers at the inception of the clinic as described in the community background section. For both the key informant interviews and the questionnaire, the source of respondents is a pool of 107 current and past volunteers at UR Well
  • Page 14 Student Outreach. Respondents for the key informant interviews were selected to represent the five volunteer positions (Health team senior, health team junior, front desk, medical assistant, referrals) and when available, were people who had volunteered 3 or more times in that particular position. The key informant interviews also included two interviews with physicians who had precepted at the clinic since the clinic’s inception. The overall goal was to have 2-3 interviewees per position with 12-15 interviews total. The questionnaire will be offered to all current and past volunteers at UR Well Student Outreach who are currently enrolled at the University of Rochester School of Medicine and Dentistry. This number will allow a more complete look at the experiences of the volunteers. Because the evaluation is concerned with determining the subjective experiences of the volunteers, having volunteers as sources for the data collected is reliable, valid, and appropriate. Logistics: Key informant interviews: Twice the number of needed respondents were contacted via email and invited to a 20-30 minute interview either in person or on phone. The purpose and voluntary nature of the interview were explained in the email. Interviews were set up and data was collected either by note taking during the interview and then adding to notes immediately after the interview was complete. All notes taken during the interviews were taken on a word processor and files were saved with no identifying information. Questionnaire: Subjects recruited will be the 107 current and past volunteers at UR Well Student Outreach who are currently enrolled at the University of Rochester School of Medicine and Dentistry. They will be recruited by email which will include the purpose as well as the voluntary nature of the study. The survey [see Appendix B] will be finalized, pre-tested, then
  • Page 15 piloted with a group of 10 volunteers to enhance validity prior to distribution to the entire group. After piloting, the survey will be distributed via email. As the study will be exempt, consent will be assumed by individuals who complete and return the survey. No identifying information will be collected on the survey itself. Responses will be returned via email to the PI of the study. Because the results of the questionnaire may be published in a peer reviewed journal in the future, RSRB approval is required. The protocol is found in appendix C. PARTNERSHIPS The significant partnerships I developed were with the stakeholders for this evaluation. I met with Adrienne Morgan, the faculty director of UR Well prior to the CHIC Clerkship to discuss the possibility of an evaluation. The members of the Steering Committee for UR Well were contacted by email. They received initial copies of the evaluation and added their comments about what the key informant interviews and questionnaire should include. Having not done key informant interviews, I partnered with Hemant Kalia, MD, MPH through class discussions to get his guidance in designing and implementing the interview. As there is no directory of student-run free clinics available, those with websites were found by searching for student-run free clinics on www.google.com. Some clinics had links to others and these were followed, as well. The list in Appendix D was created and the volunteer coordinators of the clinics were contacted and asked if they had performed evaluations of their volunteer
  • Page 16 programs before and if they had developed any tools. I heard back from 4 of these contacted clinics. While they had not had conducted evaluations themselves, they were interested in any evaluation created. IMPLEMENTATION Key Informant Interviews: The key informant interviews were developed as outlined above. Overall interest in the project was very good. Interviews were scheduled during the second and third weeks of the block either in person or over the phone depending on the volunteer’s availability. In the end, 2 physicians, 3 Health Team Senior volunteers, one of whom had also served as a medical assistant, Health Team Junior volunteers, one referrals volunteer, one front desk volunteer, and one medical assistant were interviewed. The remaining referrals and front desk interviews were unable to be scheduled due to time constraints and scheduling conflicts. The results of the interviews were compiled and will be distributed to the members of the steering committee. Questionnaire: The questionnaire, likewise, was developed as outlined above. Originally, it was hoped that a previously validated measure could be found either in the literature or from other student-run free clinics. Neither of these was found, however, and it became necessary to develop a measure specific to our project. A protocol was developed and submitted to the RSRB. This process took until the beginning of the third week of the block. Knowing that RSRB approval, even for exempt studies can take up to two weeks, it was planned that the questionnaire would have RSRB approval/exemption and be taken to the pre-piloting phase by the end of the block. This goal was attained.
  • Page 17 SUSTAINABILITY The sustainability in this project lies in the questionnaire and the development of a less time consuming method of volunteer evaluation than key informant interviews. What remains to be done is finalizing, pre-testing, piloting, and administering the final questionnaire. The questionnaire should then be given at regular intervals in order to monitor the student experiences. Consideration should be made for the balance of not overloading the student volunteers with multiple surveys, but at the same time ensuring that volunteers at all levels are being surveyed. This could be accomplished by having the clinical schedulers send the questionnaire out to all of the volunteers who participated in a particular block. This would ensure that all levels of volunteers will get the survey and the survey would be administered in proximity to the volunteer experience for better recall. In addition, if it were a part of the duty of clinic schedulers, it would be passed on year to year to the upcoming scheduler and would easily be sustained RESULTS/DISCUSSION/RECOMMENDATIONS The interviews were well received by the stakeholders, students, and physicians. Response rate was limited by time and scheduling rather than number of interested respondents. As outlined above there were 11 people involved in total, 2 physicians, 3 Health Team Seniors, 3 Health Team Juniors, 1 Referrals, 1 Front Desk, and 1 Medical Assistant. One of the Health Team Seniors had been both HTS and Medical Assistant. The estimated range of nights volunteered in this group was 2-10+ nights. All respondents said they would volunteer again in the future. Other experiences the student volunteers had providing direct medical care to underserved
  • Page 18 communities consisted of Emergency Medicine rotations, ambulatory preceptorships at Anthony Jordan Health Center, the homeless bus, providing school physicals, and volunteering at St. Joseph’s Neighborhood Center. Future career choices represented were Neurosurgery, Cardiology, Psychiatry, Internal Medicine/Primary Care, Ob/Gyn, Dermatology, Pediatrics, and undecided. The respondent going into primary care cited work at UR Well as contributing to that desire. All respondents reported that they wanted to work in some function with underserved populations in the future. Three specifically stated that their future practice would be mainly underserved populations. These three stated that they had this interest prior to volunteering, but that working at UR Well had fostered the desire. Common themes that arose during the interviews were A) Volunteers gained exposure to working with underserved communities in a unique outlet not necessarily available otherwise; B) Working at UR Well put faces to the numbers of uninsured people in the US and broke previously held stereotypes of this population; C) Working at UR Well provided an opportunity for students to apply knowledge, skills and principles learned in class; D) Volunteers developed an appreciation for delivering healthcare while being cognizant of financial restraints. These themes, each discussed by a majority of respondents, are all aspects of the intended goals for student volunteers. [See Appendix E for full compilation of responses] Taken as a whole group, all of the goals stated at the inception of the clinic have been attained. This was not true on an individual basis, however, and benefits were skewed toward health team juniors and seniors who had direct contact with both the patient and the physician. Front desk, medical assistant, and referrals volunteers, while not getting experiences such as an opportunity
  • Page 19 to appreciate the importance of cost effective medical decisions and treatment plans or an experience teaching had more experiences with the administrative side of health care. An argument can then be made that the best way to achieve the goals for each volunteer would be to serve in different positions over time. Through the suggestions of students and through evaluating student responses, the following recommendations for the volunteer program of UR Well Student Outreach could be made: • Increase front desk and medical assistant interaction with the physician—both Health Team Juniors and Seniors reported that the physician helped them through teaching and observation, however front desk, medical assistant, and referrals volunteers had little to no interaction with the physician. Their experiences could be benefited by increasing this interaction in some way. • Increase efficiency of the evening—when asked about what could be changed to improve UR Well, efficiency was a consistent answer. This is improving over time as supported by the physicians’ responses and many of the volunteers had their experiences one or two years ago. It is likely that the clinic they would work at today is already more efficient than when they first volunteered. Because it was a consistent response, however, it warrants consideration. • Increase volunteer opportunities—the group was split about how the volunteer nights are scheduled. Some wanted a more longitudinal experience available, some wanted few nights close together and some wanted few nights spread apart. The front desk volunteer appreciated the longitudinal nature of the position. Most agreed that all who were interested in volunteering should be given a chance and that this took precedence over a
  • Page 20 few people having more experience. Ideas for increasing these opportunities were through homeless outreach, other specialty clinics, and by adding a second night. • Have a list of specialist resources available for health teams and physicians to know what is possible. Putting the list on a computer would allow the list to be easily changed as resources change. • Send an email out to physician volunteers the week prior to their scheduled night to confirm that they are working. • Have specific email addresses for all members of the steering committee that would stay the same year to year even as the person changed. This would be especially helpful for the physician volunteer coordinator. • Post a list of the names, faces, and roles of the steering committee at St. Joseph’s Neighborhood Center so volunteer physicians know who the key players are. Despite having suggestions, the volunteers overall had very positive experiences at UR Well and were pressed to find something to improve on. They felt that their education was enhanced by the time they gave. These responses are supportive of moves toward expanding the capacity of UR Well. Any expansion would necessitate more volunteer involvement—either more sessions by the same volunteers, or more volunteers total. With the benefits the interviewees spoke of, either of these options would add to the University of Rochester student’s experience. It must be noted that the above findings reflect the opinions of a small number of the total volunteers at UR Well. These opinions were elicited from these particular volunteers because of their greater than average experience volunteering and thus, while more knowledgeable about
  • Page 21 their positions, they would also be more likely to have had positive experiences at the clinic as they continue to volunteer. In the future, a more objective measure given to a wider range of volunteers would be beneficial to obtain a better representation of the volunteer experience as previously discussed. Stepping out of the UR Well community and back into the larger community of student-run free clinics, while I was attempting to contact other clinics about their methods of evaluation, I noted that there was no central gathering place for students with questions about free clinics to turn to. I would highly doubt that as few clinics have evaluated their volunteer experience as reported. Had there been a forum for student run clinics, I might have been able to discuss this project and obtained other peoples ideas and advice. Similarly, after the completion of this project, dissemination of my experience in the process would be much easier. A future direction for someone interested in working with the student-run free clinic community would be to create a forum where issues that face free clinics across the country could be discussed the wheel would not have to be reinvented at every medical school across the country. IMPACT SECTIONS Project Impact: The impact of this project will be determined by what follows the results. It will be up to the steering committee to decide whether they want to incorporate any of the suggestions. Some of them are small details that are easily provided (i.e. list of steering committee members) and some are already in progress (expansion of specialty clinics and second night of clinic). Key informant interviews are time consuming and for a group that is already
  • Page 22 donating a significant amount of time to the free clinic, having a measure that is easier to administer would likely be more sustainable in the future. Personal Impact: Prior to completing this project, my future career goals included working with underserved communities on a long term basis. I feel strongly that it is my role as a physician to improve the health of all members of my community. Completing this project taught me a number of skills that I have not had before. First and foremost was the method of program evaluation. Following the steps outlined by the Centers for Disease Control Evaluation Working Group, I was able to complete one evaluation and start another. The steps are general enough that they can be applied to any type of program that requires evaluation. As I look toward working with underserved populations in the future, I am almost certain that I will be creating programs to improve health care access. In addition, through this project, I have had concrete experience developing two types of evaluations, key informant interviews and a questionnaire. Having these program evaluation skills will be vital in assessing if what I create is helpful. As part of understanding community health programs, I also researched methods of community intervention. Having even this small background is a foundation for starting community programs in the future. I have had thoughts of getting a degree in public health in the future, but seeing the tools that I might learn in a public health class has convinced me that further studies in this area will behoove the future communities I work in. This project also gave me experience in putting protocols through the RSRB. While I have had experiences with this before, this is the first protocol I have put through on my own. Questions
  • Page 23 that were answered along the way will help me in the future as additional studies will need to be put through. LONGITUDINAL EXPERIENCES The majority of my volunteer work has been with UR Well Student Outreach. I came on board the Steering Committee in 2004 as the Student Volunteer Coordinator. I was involved in the initial development of the clinic in terms of developing the clinic goals and structure, choosing a site, recruiting, training, and scheduling volunteers. I also served as a health team junior, referrals volunteer, and health team senior. My role on the steering committee ended in June of 2005, but I have continued to volunteer at the clinic. Doing this project has been an excellent way to be more involved with the clinic. In addition, it is encouraging to see that many students have had very positive educational experiences through the opportunities that the UR Well Student Outreach offers.
  • Page 24 REFERENCES: 1. DeNavus-Walt C, Proctor BD, Smith J. Income, poverty, and health insurance coverage in the united states: 2006. In: U.S. Census Bureau, Current Population Reports. Washington, DC: U.S. Government Printing Office; 2007:60-233. 2. Robert Wood Johnson Foundation. Going Without Health Insurance: Nearly One in Three Non-Elderly Americans. Available at: http://covertheuninsuredweek.org.ezp.miner.rochester.edu/media/GoingWithoutReport.pdf. Accessed September 22, 2007. 3. Coleman MS. Care without Coverage: Too Little, Too Late. Washington, DC: National Academy Press; 2002. 4. Ayanian JZ, Weissman JS, Schneider EC, Ginsburg JA, Zaslavsky AM. Unmet health needs of uninsured adults in the united states. JAMA. 2000;284:2061-2069. 5. American College of Physicians. No Health Insurance? It’s Enough to Make You Sick. Available at: http://www.acponline.org/uninsured/lack-contents.htm. Accessed September 23, 2007. 6. Shi L. Type of health insurance and the quality of primary care experience. Am J Public Health. 2000;90:1848-1855. 7. Healthy People 2010. Available at: http://www.healthypeople.gov. Accessed September 22, 2007.
  • Page 25 8. Free Clinic Foundation of America. Available at: http://www.freeclinicfoundation.com. Accessed September 23, 2007. 9. Epstein AJ. The role of public clinics in preventable hospitalizations among vulnerable populations. Health Serv Res. 2001;36:405-420. 10. Nadkarni MM, Philbrick JT. Free clinics: A national survey. Am J Med Sci. 2005;330:25-31. 11. Geller S, Taylor BM, Scott HD. Free clinics helping to patch the safety net. J Health Care Poor Underserved. 2004;15:42-51. 12. Tavernier LA, Connor PD, Gates D, Wan JY. Does exposure to medically underserved areas during training influence eventual choice of practice location? Med Educ. 2003;37:299-304. 13. Fournier AM, Perez-Stable A, Greer PJ,Jr. Lessons from a clinic for the homeless. the camillus health concern. JAMA. 1993;270:2721-2724. 14. Davenport BA. Witnessing and the medical gaze: How medical students learn to see at a free clinic for the homeless. Med Anthropol Q. 2000;14:310-327. 15. Clark DL, Melillo A, Wallace D, Pierrel S, Buck DS. A multidisciplinary, learner- centered, student-run clinic for the homeless. Fam Med. 2003;35:394-397. 16. Wilde MH, Albanese EP, Rennells R, Bullock Q. Development of a student nurses' clinic for homeless men. Public Health Nurs. 2004;21:354-360.
  • Page 26 17. Moskowitz D, Glasco J, Johnson B, Wang G. Students in the community: An interprofessional student-run free clinic. J Interprof Care. 2006;20:254-259. 18. Beck E. The UCSD student-run free clinic project: Transdisciplinary health professional education. J Health Care Poor Underserved. 2005;16:207-219. 19. Lopez G. New york city free clinic: Overview of operations . 20. Steinbach A, Swartzberg J, Carbone V. The berkeley suitcase clinic: Homeless services by undergraduate and medical student teams. Acad Med. 2001;76:524. 21. Lester HE, Pattison HM. Development and validation of the attitudes towards the homeless questionnaire. Med Educ. 2000;34:266-268. 22. Survey of Health Care Coverage and Access in Monroe County. Available at: http://www.harrisinteractive.com/news/downloads/2001_FingerLakesCharts_News.PDF. Accessed September 22, 2007. 23. Baidoo N, Baker B, Camenga D, Ebede T, Dhakal S. Family health center: A proposal by the steering committee. 2003. 24. Fleming O, Mills J. Free clinics in north carolina: A network of compassion, volunteerism, and quality care for those without healthcare options. N C Med J. 2005;66:127-129. 25. Wenger J. UR well: Expanding coverage, increasing opportunities. 2006. 26. Centers for Disease Control and Prevention. Framework for program evaluation in public health. MMWR. 1998;48:RR-11.
  • Page 27 Appendix A: Key Informant Interview Questions Tell me about your experience volunteering at UR Well Student Outreach. What volunteer positions have you held? How many nights have you volunteered? What were your reasons for volunteering? Will you volunteer again? What is your opinion of the structure of the volunteer positions? What other experiences during medical school have you had providing direct medical care to an underserved population? Working in the inner-city? What are the benefits and drawbacks to working at UR Well? What did you gain from volunteering? Any aspect of the volunteer experience that you did not like? Any aspect you think could have been better? In what ways did you learn from your time at UR Well? What principles and skills from the classroom could you apply? (PEx, clinical reasoning, sensitivity to culture) How did the physician contribute to your education? Did you have an opportunity to teach? In what ways, if any, did you gain exposure to the administrative, financial and human management aspects of medicine? In what way working at UR Well changed your awareness of insurance disparities? What particular patients or experiences stand out in your mind? In what way did the financial situation of the patient play a role in your decision and treatment plan? What career are you considering following? In what way, has your work at UR Well influenced this? Attitude toward working with underserved populations in the future? Influenced by UR Well? If you were given a chance to change one thing in the system here what would you do which will be beneficial for the future volunteers? Anything else you would like to tell me that I did not ask about? Thank you very much for your time. Your experiences and insights are very helpful to us. The information from the interviews will be compiled by the end of this month. Would you like to receive any follow up information upon its completion?
  • Page 28 Appendix B: Candidate questions submitted to RSRB for final questionnaire Please check the positions you held and list the year you held them: • Front Desk MS year: • Medical Assistant MS year: • Health Team Junior MS year: • Health Team Senior MS year: • Referrals MS year: How many total hours have you volunteered at the clinic? Patient contact : During each year, how many patients did you see per night? Were you satisfied with the amount of patient contact? Was the amount of patient contact worth the time you spent volunteering? Did you feel as though you had a sufficient amount of time to care for your patients? Enrichment of education: Did you have any experiences at the clinic that you might not otherwise have had? Did you learn while you were at the clinic? As a first or second year were you able to apply what you have learned thus far in your medical education? In what way? As a third or fourth year were you able to apply your medical education at the clinic? In what way? How did the physician contribute to your education? Did you meet physicians that you might not have otherwise met? Exposure to every aspect (administrative, financial, health management) of health care Did you deal with any of the following aspects of health care of while working at UR Well? Check-in, Check-out, Laboratory, Laboratory paperwork, Scheduling, Follow up, Referrals, Insurance/Medicare/Medicaid, Prescriptions What was your level of understanding of the aspects of running a clinic prior to volunteering? What was your level of understanding of the aspects of running a clinic after volunteering? Opportunity for hands-on medical education and knowledge application of principles and skills learned throughout the medical curriculum What principles or skills that you learned in your medical education did you apply to your work at UR Well? (eg biopsychosocial model, techniques learned in class) What skills did you utilize at UR Well? Patient interviewing; Physical Exam; Vital signs; Blood draw; PPD; Urinalysis; EKG; Blood glucose; I & D Improved awareness of the insurance disparity as a public problem What was your level of awareness of the problem of lack of medical insurance prior to volunteering? What was your level of awareness after volunteering? Were there any experiences in particular that influenced your awareness of insurance disparity as a public problem? Opportunity to appreciate the importance of cost-effective medical decisions and treatment plans by more carefully considering their effects on patients How often was cost a factor in your treatment plan? Was your treatment plan ever altered based on the patient’s ability to pay? If so, how often? What was your level of understanding of costs of healthcare prior to volunteering? After?
  • Page 29 Appendix B: Candidate questions submitted to RSRB for final questionnaire Exposure to an inner-city primary care Health Center Prior to working at UR Well, had you worked or volunteered at a primary care health center? Are you aware of any other opportunities to provide direct medical service to an underserved population? Have you taken part in any of these? Inspire future physicians to consider entering a career with significant attention to the care of medically underserved populations Prior to working at UR Well, were you considering a career with significant attention to medically underserved populations? Has working at UR Well changed this? If there was a change, to what do you attribute the change? Maintain medical student interest in social justice, primary care, and the medically underserved Prior to working at UR Well, were you interested in social justice? Has working at UR Well changed this? If there was a change, to what do you attribute it? Prior to working at UR Well, were you interested in primary care? Has working at UR Well changed this? If there was a change, to what do you attribute it? Preparation for teaching Did you have an opportunity to teach your fellow students? While serving what role? Did you have an opportunity to teach your patients? While serving what role? Building relationships with a community-based organization Prior to working at UR Well, had you done work with St. Joseph’s Neighborhood Center? After working at UR Well, have you done work with St. Joseph’s Neighborhood Center? If so, did your volunteering at UR Well play a role? General Overall, how would you rate your experience? 1: not worth my time……………………………………………..10: Worth Every Minute What were the benefits you received from working at UR Well? What were negative aspects of working at UR Well? Was there anything that could have been done differently? Will you volunteer again? If yes, why? If no, why not?
  • Page 30 Appendix C: Protocol for RSRB Exemption Approval Evaluation of the Student Volunteer Experience at UR Well Student Outreach I. PURPOSE OF THE STUDY AND BACKGROUND Purpose of the study: The purpose of this study is to develop and implement a survey to determine the benefits and areas needing improvement of the student volunteer program at UR Well Student Outreach. Background: University of Rochester School of Medicine and Dentistry students have a strong history of involvement in the Rochester community. Over the last sixteen years, the community outreach program has placed over 1200 students at various agencies throughout the Rochester, providing free school physicals, supporting patients in the hospital, tutoring for inner-city school children, among other activities. In 2003, the idea of expanding these opportunities to include a student-run free clinic was born. A core group of students under the direction of Adrienne Morgan attended conferences, visited other free health clinics, researched clinic staffing structures, and surveyed the Rochester community to better understand what needs were not being addressed. With the gathered information and experiences, a model and plan for Rochester’s first student-run free clinic was developed1. The core group expanded in the winter of 2003 to form a steering committee consisting of several teams: clinical coordinator, administrative coordinator, student volunteer coordinator, physician volunteer coordinator, referrals, pharmacy, financial director, clinic director, statistics and public relations. In spring 2004, the steering committee partnered with St. Joseph’s Neighborhood Center, a health center operating in the Southwest neighborhood, to use their facilities on Tuesday nights. The clinic opened its doors on September 14th, 2004 with the mission of “providing free, high quality health maintenance and preventive services to local uninsured families and individuals in an effort to foster the health of the Rochester community, while promoting the spirit of education, social justice and collaboration.”1 While the steering committee still organizes and guides the clinic, it is the student and physician volunteers that come each week that allow the clinic to run. The volunteer model of the clinic (see below) is based on the New York City Free Clinic implemented by New York University School of Medicine.4 It consists of a front desk team who checks the patient in and out, a medical assistant who takes vital signs and puts the patient in the room, a health team of a second year medical student and a fourth year medical student who sees the patient, an administrative coordinator who works at the front desk to manage logistics and a clinical coordinator who works with the health teams to answer questions and facilitate the evening. The health teams report to a volunteer physician and discuss the plan for the patient. Referrals made on the clinic night are followed up by a separate volunteer who comes in during the week. The model was chosen to provide the best educational experience to the volunteers while still providing high quality health care to the patient. [See appendix C of final paper] Under this model, the following goals for the student volunteer experience were laid out: • Opportunity for hands-on medical education and knowledge application of principles and skills learned throughout the medical curriculum • Improved awareness of the insurance disparity as a public problem • Opportunity to apply human faces to the staggering numbers of uninsured persons • Opportunity to appreciate the importance of cost effective medical decisions and treatment plans • Exposure to an inner-city primary care health center • Inspire future physicians to consider entering a career with significant attention to the care of medically underserved populations • Provide a unique and important outlet to students seeking an opportunity for direct medical service to an underserved population • Maintain medical student interest in social justice, primary care, and the underserved • Exposure to the financial and human management of medical services • Experience in teaching
  • Page 31 In a clinic that would be sustainable across the years.1 Appendix C: Protocol for RSRB Exemption Approval Student volunteers are the substance of the clinic and ensuring and enriching experience is vital to the continuation and growth of the clinic. The clinic thus far has been very successful and student interest continues to be high. Maintaining volunteer interest to staff free clinics over time can be challenging.3 Discussions of expanding the clinic to include an additional night or provide other services are on the table.5 This, naturally, would require more involvement by the student volunteers. As UR Well Student Outreach looks to the future of expanding the hours of the clinic and the resources that clinic offers, it is essential that the experiences of the volunteers are understood. Search of the literature about evaluation of volunteer programs and in particular volunteer experiences at student run free clinics is sparse. A preliminary, unpublished study of attitudes of student volunteers toward working in underserved populations has been mentioned in the literature but not published to date.2 Contact with other student- run free clinics around the country reveals other groups are interested in evaluating their own volunteer programs, but no evaluation protocols already in place. A need exists to develop a tool to evaluate the volunteer experience specifically for the student volunteers at UR Well, but also a tool that could be used by other student-run clinics. II. CHARACTERISTICS OF THE RESEARCH POPULATION The total number of expected respondents will be 75, approximately 30% male and 70% female in line with the population of volunteers at UR Well Student Outreach. Respondents will all be over the age of 18 years. There will be no restrictions on the basis of race or ethnic origin. Inclusion criteria will be enrollment at the University of Rochester School of Medicine and Dentistry and past or present involvement as a volunteer at UR Well Student Outreach. Respondents will only be excluded if they do not fit inclusion criteria. No vulnerable populations will be involved. III. METHODS AND PROCEDURES Procedures: The format of this study will be a community survey of the population of student volunteers at UR Well Student Outreach. There are 107 active and past volunteers at UR Well currently enrolled at University of Rochester School of Medicine and Dentistry. The survey [see Appendix G of final paper] will be piloted with a group of 10 volunteers to enhance validity prior to distribution to the entire group. After piloting, the survey will be distributed via email. No identifying information will be collected on the survey itself. Responses will be returned via email to the PI of the study. Data Storage and Confidentiality: The volunteer responses will be saved onto a password-protected hard drive. No identifying information will be kept. Any emailed copy of the response will be permanently deleted from the PI’s mailbox. Data responses will be collated into a spreadsheet containing no identifying information. This spreadsheet may be used by members of the steering committee of UR Well Student Outreach. Data Analysis: Descriptive statistics will be used to summarize the data received. Chi square analyses, ANOVA, and t-tests will be used where appropriate. Publication: The PI reserves the right to publish the survey and the data obtained in the survey in a peer-reviewed journal. IV. RISK/BENEFIT ASSESSMENT 1. Risk Category: Minimal 2. Potential Risk: None 3. Potential Benefits to the Subjects. Improvement of the UR Well Student Outreach Volunteer Program to better serve their needs V. SUBJECT IDENTIFICATION, RECRUITMENT AND CONSENT/ASSENT 1. Method of Subject Identification And Recruitment: Subjects will be recruited through email solicitation of those who are actively volunteering or who have volunteered in the past at UR Well Student Outreach. 2. Process of Consent: As this is an exempt study, written consent will not be required. The initial recruitment email will be an information letter that will describe the nature of the survey and detail that the study is entirely voluntary.
  • Page 32 Appendix C: Protocol for RSRB Exemption Approval Sources Cited 1. Baidoo N, et al. Free Family Health Center: A Proposal By the Steering Committee. Unpublished proposal. 2003. 2. Beck E. The UCSD Student-Run Free Clinic Project: Transdisciplinary Health Professional education. Journal of Health Care for the Poor and Underserved. 2005; 16: 207-219. 3. Fleming O, Mills J. Free clinics in North Carolina: a network of compassion, volunteerism, and quality care for those without healthcare options. North Carolina Medical Journal. 2005; 66: 127-129. 4. Lopez G. New York City Free Clinic: Overview of Operations [Presentation]. Medical Student Run Free Clinic Conference at New York University. 2004. 5. Wenger J. UR Well: Expanding Coverage, Increasing Opportunities. Unpublished Report. 2006.
  • Page 33 Appendix D: Partners 1. Hemant Kalia, MD, MPH Resident General Preventative Medicine/Public Health Department of Preventative and Community Medicine 270.223.6078 hemant_kalia@urmc.rochester.edu 2. Adrienne Morgan Director, CACHED University of Rochester School of Medicine and Dentistry Adrienne_morgan@urmc.rochester.edu 3. UR Well Student Outreach Steering Committee Email Name Role Address Zachary Borus Clinic Director global Janaki Nathan Referrals global Karim Boudadi Referrals global Domenic Roma Clinic Coordinator global Tracy Fuller Clinic Coordinator global Allison Panzer Clinic Coordinator global Annabel Fu Administrative Coordinator global Kristopher Denby Administrative Coordinator global Ashley Poelma Administrative Coordinator global Ashley O'Hara Administrative Coordinator global Keri Allen 2nd yr Clinic Scheduler global Jacqueline Zayas 4th yr Clinic Scheduler global Patrick Francis Fundraising/Finance global Annabelle de St. global MD Recruitment Maurice Kate Diaz Stats global Kate Diaz Pharm global Aleksey Tentler Public Relations/Website global Summer Chapin At Large global Jessi Kaur At Large global Jesse Wenger At Large global Nikki Burr At Large global
  • Page 34 Appendix D: Partners 4. Student Run Clinic Contacts School Clinic Name Volunteer Contact info Website UCSD UCSD Free Clinic Project fcp-volunteers@ucsd.edu http://meded.ucsd.edu/freeclinic/services.html MSSM EHHOP http://eastharlemhealth.org Cornell http://wccc.med.cornell.edu/ Einstein ECHO http://www.echo-clinic.org/index2.php?page=volunteers.php Columbia CoSMO Stanford Arbor Free Clinic http://pacific.stanford.edu/ NYU NYC Free Clinic http://www.med.nyu.edu/nycfreeclinic/contact/contact.html UC Davis Imani Clinic http://cim.ucdavis.edu/clinics/imani/contact.htm U Kentucky http://www.mc.uky.edu/saclinic/student.htm Baylor HOMES Clinic http://www.homeless- healthcare.org/homesprogram/contact.htm Tufts Sharewood Clinic http://www.sharewood.info/board.php Yale U of UR Well Rochester U of IL U-C HeRMES info@hermes-clinic.org http://hermes.navsaria.com/ Vanderbilt Shade Tree free.clinic@vanderbilt.edu http://www.shadetreeclinic.org MUSC CARES Clinic Megan Knight http://www.thecaresclinic.org knightmc@musc.edu Elizabeth Norman normane@musc.edu UIC SRFC Neal Sawlani nsawlani@uic.edu http://www2.uic.edu/stud_orgs/prof/clin/ UTHSCSA Student run clinics Vannessa Sweet http://studentrunclinics.org/index.cfm sweetv@uthscsa.edu Texas A&M Martha’s Health Clinic Lee Lee Nguyen http://medicine.tamhsc.edu/lrc/clinic/ hknguyen@medicine.tamhsc.ed u UMMC Jackson Free Clinic volunteer@jacksonfreeclinic.org http://www.jacksonfreeclinic.org/ Northwester Devon Clinic Walid Alrayashi n w- alrayashi@md.northwester.edu Kansas U JayDoc Clinic http://volunteer.jaydocfreeclinic.org/index.php Chicago Student Run Clinic CCOMClinic07@gmail.com http://www.freewebs.com/ccomclinic/ COM U Penn United Community Clin. eblanm@mail.med.upenn.edu http://www.med.upenn.edu/ucclinic/leadership.html
  • Page 35 Appendix E: Key Informant Interview Responses Tell me about your experience volunteering: Reasons for volunteering Health Team Senior • Good opportunity to help community • To work in an underserved population • Benefits for patients and students • An opportunity for independent learning • To practice clinical and interviewing skills Health Team Junior • To provide a needed service • To work with an underserved population • To have a more autonomy than work in preceptors office • To have a different type of activity than what is provided in class Referrals • To provide healthcare to people without insurance Front Desk • To work with underserved populations • To prepare for future work with a free clinic Medical Assistant • To gain clinical experience • To provide healthcare to uninsured Physicians • To support the project • Provide opportunity for medical students to work with underserved populations and family physicians • Encourage students to have a sense of responsibility • Enjoy working with medical students Tell me about your experience volunteering: Opinions of structure of volunteer positions Health Team Senior • Great: it mirrors hierarchy in medicine • Role of medical assistant could be taken over by health team to increase efficiency • Strength is allowing 4th year student to teach 2nd year • Beautiful, perfect: allows patient contact for 1st years and more teaching for 2nd years Health Team Junior • Liked that 2nd year was able to contribute and 4th served as back up • Good to get 1st years involved in front end Referrals • Good to have referrals come on a separate night because most places must be contacted during business hours Front Desk • There is a disconnect between the number of interested first years and the number of spots available • Front desk is good for first years to gain exposure consistent with their level of expertise • Medical assistants lack continuity with only 3 sessions per year Medical Assistant • Medical Assistant position provides practice for 1st year • Health team jr/sr combo allows for teaching of jr Physician • Allows students enough to have enough knowledge to formulate a plan • Some pairs work better than others • Don’t really see what goes on in the front end What are benefits and drawbacks to working at UR Well: Benefits Health Team Senior • Training to become a better doctor • Opportunity to serve the underserved • Practice creativity in treatment plans due to financial restraints • Work in a nourishing environment with appreciative patients • Have a chance to teach fellow students Health Team Junior • Gain experience with a new set of medical issues • Improve interviewing and physical exam skills
  • Page 36 • Rewarding to work with appreciative patients Referrals • Learning to navigate the system in terms of finding referrals, setting up appointments Front Desk • Be able to see how a clinic is run • Be able to meet patients and get exposed administrative side Medical Assistant • Be able to meet patients from varied backgrounds • Gain experience with issues that a good proportion of city faces • Rewarding to work with appreciative patients What are benefits and drawbacks to working at UR Well: Drawbacks Health Team Senior • Inefficiency of the clinic • Inability to volunteer more frequently • Unhealthy food in the back room • Working under financial constraints Health Team Junior • Occasionally long days volunteering • Inefficiency of the clinic Referrals • Not all interested people can be involved • Coming in outside of the hours of clinic can be awkward Front Desk • Not always knowing what to do, this improves with time Medical Assistant • Downtime if patients no show • Not always clear about paperwork—would be good to have better orientation to patients’ paperwork. In what ways did you learn from your time at UR Well? Health Team Senior • Applying the biopsychosocial model to address needs of underserved • Applying concepts taught in class to patients • Teaching health team juniors Health Team Junior • Applying physical exam and interviewing skills • Learning importance of financial considerations • Opportunity to teach patients about their disease, smoking cessation • Observation of health team senior • Getting feedback about performance from multiple people Referrals • Applying HIPAA concepts to work while calling patients Front Desk • Learned that uninsured doesn’t mean unemployed • Learned other barriers to healthcare eg time constraints due to multiple jobs, transportation • Applied smoking cessation Medical Assistant • Improvement of skills learned in ICM • Increased awareness of new issues • Learning importance of financial considerations • Teaching patients about hypertension, physical activity, smoking cessation How did the physician contribute to your education? Health Team Senior • Teaching on topics pertinent to patient • Allowing health team senior to decide plan • Observing how veteran clinician analyzes and synthesizes problems • Working with physicians who are motivated to care for underserved populations Health Team Junior • Teaching on topics pertinent to patient • Observing physician with patient • Willing to teach and motivated to be at clinic • Having them observe skills and comment on presentations and notes Referrals • No interaction with physician Front Desk • No interaction with physician Medical Assistant • Not much interaction with physician
  • Page 37 In what ways did you gain exposure to admin, financial, and human management aspects of medicine? Health Team Senior • Learning about $4 prescription plan • Filling out billing codes on sheet • Providing prescriptions and selecting based on balance of compliance and cost • Providing labs and considering costs • Added to knowledge of insurance disparities • Meeting needs with limited resources • Put faces to numbers of uninsured patients Health Team Junior • Filling out forms • Determining when patients should return for follow up • Logistics of ordering and drawing labs • Arranging for referrals • Putting faces to numbers of uninsured patients—working, homeless, lost jobs • Learning about $4 prescription plan Referrals • Financial side as referral resources were scarce without insurance • Issues with coordinating patients and providers Front Desk • Answering phones, scheduling patients, collecting fees • Checking patients in and out • Drawing labs Medical Assistant • Being a part of process of taking patient back and getting them ready for team • Putting faces to numbers of uninsured patients—even children What would you change about the clinic to benefit future volunteers? Health Team Senior • More efficient scheduling: have online scheduling where you could pick days you are available • Have a database to track patients who return frequently to monitor the quality of their care • Nothing, the clinic runs well as it is • Provide more longitudinal volunteer opportunities Health Team Junior • Would like more longitudinal volunteer opportunities but this must be balanced with getting people who are interested involved • Get a sheet when you arrive detailing your responsibilities Referrals • Get more people involved Front Desk • Get anyone who is interested involved Medical Assistant • Allow medical assistant to go into room with patient to get more full exposure of the patient experience Physician • Have a list of specialist resources perhaps on a computer so that it could be changed as resources change • Send an email out to physician volunteers the week prior to their scheduled night to confirm that they are working • Have individual email addresses for all members of the steering committee that would stay the same year to year even as the person changed. This would be especially helpful for the physician volunteer coordinator. • Consider adding another night, other specialties (you can rotate specialty), homeless outreach What are the strengths and challenges of the clinic: Strengths Physician • Organization • Pairing of health team junior and senior • Students involved in all aspects of clinic • Clinic is more efficient than it was when it first started and is seeing more patients • Advocacy for patients: follow up for issues and referrals is very good
  • Page 38 • Students access available resources well What are the strengths and challenges of the clinic: Challenges Physician • Staying within allotted times Can you tell me about the transition of the clinic from year to year? Physician • Goes well in terms of recruiting • Would be good to have names and pictures of steering committee for physicians so key people are recognized • Some historical information is lost from year to year, but all major information is passed on • No barriers to the clinic remaining open in the future • Clinic relies heavily on core volunteers who put in an incredible amount of effort to maintain success of clinic, if leadership in this group were poor one year, the clinic might not survive