1. What is the role of Student Run Clinics?
Christy Meyer, Melissa Gosdin, Ph.D, Jenna Dekeater, Patrick Romano, M.D., and the SRC Research Consortium
with the support of the Center for Healthcare Policy and Research at UC Davis
Who We Are
Background and Aims
Participating Clinics
UC Davis, like most medical schools today, is proud of its Student Run Clinics (SRCs), which serve a wide variety of communities. However, these clinics operate on few resources, and some believe that SRCs do more for students than the patients. This is reflected in the national literature about SRCs, which overwhelmingly focus on student, rather than patient, experiences. However, in a time of expanded Medicaid, when the number of uninsured patients has dropped to historic lows, our SRCs have experienced very little decrease in the demand for services. We found this curious, so we wanted to take the opportunity to ask our patients directly, as no other known study has: What motivates patients to utilize SRCs in the context of other perceived options? What improvements can be made so that SRCs can better serve their communities? We hoped that answering these questions would provide valuable insight to medical school administrators, to volunteer co-directors anxious to improve services, and to policy makers who are concerned about ongoing gaps in the health care delivery system.
• Bayanihan Clinic: “First opened to serve the Filipino Veteran community and has now expanded to encompass the diverse communities of Sacramento.”
• Clinica Tepati: “Serving downtown Sacramento's underserved and undocumented Latino population.”
• Imani Clinic: “Imani is a Swahili word meaning faith and it symbolizes the hope students wish to foster within the African-American community.”
• Joan Viteri Memorial Clinic (JVMC): “Unbiased health care to intravenous drug users, sex workers and their families.” • Affiliated Clinic: Gender Health Center (GHC): “Care for the LGBTQQI community, with a focus on transgender health.”
• Paul Hom Asian Clinic (PHAC): “For the Asian and Pacific Islander community. Founded in 1972, it is the oldest Asian health clinic in the United States.”
• Shifa Clinic: “Adjacent to a mosque in downtown Sacramento, the clinic primarily serves patients from the South Asian and Muslim communities.”
• Willow Clinic: “The clinic provides health care screening and services to a large, homeless population.” all quotes from
Themes and Evidence
We identified four major themes in the interviews and have arranged subthemes with supporting quotes from participants.
Community
Recommended by family/friends
“I heard about [PHAC] from my friends… They told me it was great for older people who did not understand English.” -PHAC
Language “I just applied and got MediCal. There’s a language barrier and I don’t really know how to use it.” -PHAC
Compassionate Care “Thank you for the respect you have for us. For me that is a true doctor. Thank you for being professional and helping our community without judging our race or status and hope you can keep doing this.” –Imani
Reciprocity with Students
“I see it as a good thing for them and us at the same time because one day they will be the ones helping us.” –Shifa
Accessibility
Cost
“Obamacare didn’t help at all. You know, premiums were going to be just as high or higher than what we were paying, you know with Covered California.” -Tepati
Distance
“It’s nearby… it’s got food and it has a nursing place. And it has good counseling in here.” –Willow “It was far and still I want to go there even though it’s far because of the service and I have more confidence in them. But now, this is... very accessible.” -Bayanihan
No other form of insurance
“I don’t have any insurance I’m signed up with yet, cause I was kinda falling through the cracks on a lot of things.” -JVMC
Weekend hours “I can come here on Sundays; leave my kids with my husband.” -Imani
• 41 undergraduate researchers contributed. • 104 individual interviews with patients were conducted over three months in Fall, 2017.
• Interviews were translated and transcribed from six languages by native speakers.
• 7 Student Run Clinics and one affiliated, professionally managed clinic were represented at UC Davis SOM, in Sacramento, CA.
Limitations and Next Steps
Data are still being analyzed for publication and release to the clinics, and not all interview data have been represented in this poster.
Three undergraduates are preparing projects based on this work: • Exploring the motivations and barriers that affect potential precepting physicians. • Following up with our cohort to learn how the process of conducting these interviews affected their understanding of patient care. • Further assessment of mental healthcare needs.
We hope these interviews will provide the foundation for quantitative research hypotheses and policy decisions in the future.
Methods
Interview questions were created in consultation with co-authors Melissa Gosdin, Ph.D, expert in qualitative research design, and Dr. Patrick Romano, MD, MPH, who both precepts SRCs and is a widely published researcher and public health professor with the Center for Healthcare Policy and Research at UC Davis.
Students were recruited from the current SRC undergraduate volunteer populations for three reasons: 1. The majority of the SRCs are geared toward specific immigrant populations with frequent language barriers. Those who self-select to volunteer in those clinics are more likely to be able to effectively transcend those barriers. 2. Knowledgeable SRC volunteers would be less likely to disrupt the normal flow of busy clinic activity.
3. We hoped to engage pre-health professions students in an educational experience related to effective listening and qualitative research.
Invited undergraduate researchers each completed CITI certification in biomedical research to meet IRB standards. Upon completion, they came to a half-day training session on how to collect qualitative data, including verbal consent and audio recording procedures.
35 students completed the interview phase and were invited to return to a second training on open coding data line-by-line for qualitative research, as members of the SRC research consortium.
Students worked in pods to achieve inter-coder in the findings. Each interview was audio-recorded and transcribed verbatim. All transcripts were analyzed by students according to their pod assignments. Independently, students open coded all transcripts. Codes were later collapsed into categories and then themes. These “master codesheets” were then sent to the study’s lead authors.
Two lead authors then utilized a grounded theory approach to identify themes and to include supporting quotations from all 104 interviews across clinics.
Acknowledgements
We are grateful to the Deans, Preceptors, and Co-Directors of the Student Run Clinics for trusting us with their patients and this research.
Preference
Feeling respected
“They give us more attention, they listen to us here… They inspire my trust to say what I feel.” -Imani
Mistrust of the ER
“I don't trust going into the emergency rooms or hospitals anymore… They called CPS on me and I got my son taken for trying to get medical care.” -JVMC Doctors just as good if not better
“Not just looking at patients or writing medicines, they even touch your feet and check everything thoroughly. That’s what I’ll tell others. Even your birth mother doesn’t do that. Very nice thoughtful people.” -Shifa
Thoroughness “I would prefer to come here 1,000 times more than paying at another place. Here they ask the necessary questions to know what’s wrong with you.” -Imani
Room for Improvement
More doctors
“It’s a small place and the service is, ‘Wow,’ excellent and if you had a larger place where you could take in more people, that’s what I would say I would want for this clinic, or if there were just more places like this clinic.” –Shifa
Old equipment
“The stethoscopes and blood pressure cuffs do not work a lot of the times.” -PHAC
Lack of advertisement
“Just, like, let more people know it’s there.” -GHC
More services and education needed “Booklets about dental health, people with dental health problems can learn how to take care of the teeth. As well as eyes and others. If there is some information, I think people will read them. People are just sitting there and waiting.” –PHAC