Letting Students Run the Clinic - Article

[Mt Kilimanjaro]

Thought-provoking article in the Atlantic about student-run clinics.

Every clinic I know of is supervised by attendings affiliated with the medical school, so the quality of care can't be that far off from what you'd get in a teaching hospital. These clinics largely function as urgent care centers for people in the margins between Medicaid eligibility and employer sponsored insurance. If they provide totally free care and keep people out of county EDs, then that seems like a win-win for the patient and the health care system.

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[KnuxNole]

I mean, every word that the med student says will be checked by the attending. It's not the student will do anything independently other than a history and physical(order tests, meds, etc). So, I don't see any problem with student clinics where attendings see the patients and take care of the management part.

 

[Lya]

Check out the thread about dying in the safety net, and recognize the difference.

In my opinion, student-run clinics will flourish and some of them will provide quality care, while having great clinical education as its return. I have no doubt about that, depending on what exactly patients need. However, the clinical resources and equipments of such clinics tend to be far less capable than those of other larger hospitals, and those in need of chemotherapy and surgery, for instance, will find free clinics insufficient. For preventive care purposes like offering free mammography, students-led clinics seem to be excellent in that regard, although things can be improved to be more proactive.

In short, these free clinics are helpful, but I think they are not the final answer to the healthcare service gap.

 

[styphon]

We also have a student run clinic in the city - but there are always one or two family med attendings present - and occasionally a derm attending (gasp!!). The students manage stocking supplies, ordering, setting up schedules - so they do learn elements of practice management - and I guess "run" the place.

 

[tantacles]

Check out the thread about dying in the safety net, and recognize the difference.

In my opinion, student-run clinics will flourish and some of them will provide quality care, while having great clinical education as its return. I have no doubt about that, depending on what exactly patients need. However, the clinical resources and equipments of such clinics tend to be far less capable than those of other larger hospitals, and those in need of chemotherapy and surgery, for instance, will find free clinics insufficient. For preventive care purposes like offering free mammography, students-led clinics seem to be excellent in that regard, although things can be improved to be more proactive.

In short, these free clinics are helpful, but I think they are not the final answer to the healthcare service gap.

They can be the answer for some gaps. For example, we can provide a prescription for Metformin and other commonly prescribed medications at a very low cost. Normally, the barrier to entry is paying for your clinic visit, so a prescription costs you the medication cost + the appointment cost.

With regard to surgery and chemotherapy, many family practice and internal medicine physicians refer for that kind of care in any case, which is exactly what our clinic would do if we had a patient in whom we suspected or detected cancer.

And finally, with regard to equipment, my school's free clinic, at least, is housed in our University-affiliated health center, and we have access to most, if not all, of the health care resources our health center does.

 

[Planes2Doc]

"In fact, she worries the experience might even reinforce negative beliefs, namely that it is permissible for students to learn by practicing on the impoverished."

I think that this is pretty true, even if people don't think about this consciously.

For instance, if you're a pre-med and have the choice between volunteering in a hospital ED or free clinic, people will tell you to do the free clinic. Why? Because you get to do more.

Interestingly, a well-to-do hospital will not let volunteers touch the patient. You might be able to a lot of things far beyond your scope of practice on a poorly run mission trip, but admitting it will look terrible since you were obviously taking advantage of the poor to do things.

But free clinics? Just like the third bowl of porridge in the story of the three little bears, it's just right.

I realize that the article is in reference to student run clinics, but lots of pre-meds, especially in the pre-allo board wish to volunteer at free clinics for their applications.

 

[OCDOCDOCD]

Check out the thread about dying in the safety net, and recognize the difference.

In my opinion, student-run clinics will flourish and some of them will provide quality care, while having great clinical education as its return. I have no doubt about that, depending on what exactly patients need. However, the clinical resources and equipments of such clinics tend to be far less capable than those of other larger hospitals, and those in need of chemotherapy and surgery, for instance, will find free clinics insufficient. For preventive care purposes like offering free mammography, students-led clinics seem to be excellent in that regard, although things can be improved to be more proactive.

In short, these free clinics are helpful, but I think they are not the final answer to the healthcare service gap.

That's not exclusive to student run clinics though, that goes for all free clinics. They're just free primary care clinics, so they're ill equipped to handle anything that requires special treatment or diagnostic procedures. It's just like how your PCP has to make referrals in the same situations, the main difference being that in your case you have insurance so you can actually use those referrals whereas in the case of free clinic patients they have no access to health care outside of swamped free PCP centers and EDs.

 

[SouthernSurgeon]

I've volunteered in two student clinics, one as a student and one as a resident. It's obviously anecdotal, but the idea that the attendings are truly "overseeing" all aspects of care is laughable. It ultimately falls on the student leaders of the clinics to chase down test results, coordinate follow-up, keep track of documentation. The attendings show up for a few hours, spout out the usual platitudes they do on rounds, then disappear. It's exceptionally rare for an attending to truly take ownership over the student clinic patients. I don't imagine they are so cavalier with their own practice.

The level of attending oversight is equal to, or inferior to, what is seen in resident-level continuity clinics. Except instead of a resident running the show it is pre-clinical med students who have barely even heard of most of the current clinical guidelines.

 

[KnuxNole]

Do the attendings at least see the patients and prescribe all the meds? Cause you gotta fix the plethora of mistakes the student will make if not :O

That would be scary if the student does a test or a med behind the attendings back...I'd imagine everything they do would be checked by an actual doctor...