bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Student-Run Free Clinic Participation on Medical Student Attitudes Towards the Underserved: A Mixed-Methods Approach
Authors: Enich Michael , Hawes Meagan , Lavadera Paul , Lin Karen Wei-Ru 
Published: May 2023

Background: Student-run free clinics provide an opportunity to shape medical student practices with and attitudes towards the medically underserved. Previous literature has shown mixed results on how student attitudes change over the course of medical education. The purpose of this mixed-method study is to determine the effect that participation in a student-run free clinic has on medical student attitudes towards the underserved as compared to attitudes of non-participating students.
Methods: The validated Medical Attitudes Towards the Underserved (MSATU) survey was administered in cross-sectional study to student participants in a student-run free clinic and to non-participating medical students (n = 122). Additionally, first and fourth year participant students were interviewed via semi-structured interviews about results.
Results: There was no statistically significant difference in overall MSATU scores between participant and non-participant medical students using Mann Whitney tests. In sub-score analyses, Mann Whitney tests demonstrated significantly higher scores among participants in the total services score (U = 1344.0, df = 115, p = 0.013) and the expensive procedures services sub-score (U = 1401.0, df = 115, p = 0.019). Interviews revealed that positive attitudes towards the underserved are not specific to student-run free clinic participants. Participants did not describe changes in their attitude from clinic participation, believing all medical students had a baseline positive attitude towards the underserved. They did, however, highlight that witnessing the reality of these patients influenced their perspective and future practice.
Conclusions: There were limited significant differences in MSATU survey scores between participant and non-participant students. Interview results suggest that the survey tool was unable to capture changes in the perspectives of participant medical students or the changes in their projected practices but that, participation in a student-run free clinic had an overall positive effect on understanding of the barriers to care and empathy towards the underserved.
Impact of an Additional Immunizing Pharmacist at an Interprofessional Student-led Clinic for the Underserved
Authors: Patel Khyati , Candelario Danielle , Rahman Ateequr , Chen Melissa 
Published: May 2023

Background: To streamline workflow during peak influenza season in our weekly student-led free Interprofessional Community Clinic (ICC), an additional pharmacist shift solely responsible for providing immunization services was implemented from October 2018 to February 2019. The objective of this study was to determine the impact of adding an immunizing pharmacist, in addition to a clinical pharmacist, on adherence to Centers for Disease Control and Prevention (CDC) vaccine recommendations and overall immunization rates at ICC.
Methods: A retrospective chart review of patient visits from October 2017 to February 2019 was conducted. Vaccination rates and CDC recommendation adherence were compared to a historical control when an immunizing pharmacist was not scheduled. Chi-square analysis was performed on categorical data; Fisher’s exact test was used to assess impact of an immunizing pharmacist on vaccination rates and adherence to CDC recommendations. A p-value of <0.05 was considered statistically significant.
Results: A total of 78 patient visits and 58 unique patients were included. There was a significant increase in the adherence to CDC recommendations for pneumococcal vaccine when an immunizing pharmacist was present (p=0.02). There was no significant difference in the adherence to CDC recommendations for all other vaccines and overall vaccine rate between the two groups (p>0.05).
Conclusion: Implementation of an immunizing pharmacist in an interprofessional clinic significantly impacts the adherence to CDC recommendations for pneumococcal vaccine without significantly impacting the overall vaccine rate. Benefit of an additional pharmacist dedicated to vaccinations should be weighed for workflow improvement versus impact on vaccine adherence and rate.
Delivering Comprehensive Social Services during a Pandemic: Experience of a New York City Student-Run Free Clinic
Authors: Dias Jennifer , Lui Madeline , Goldberger Cody , Stewart O'Jay , Deeb Stephanie , Orozco Scott Paloma , Berger Natalie , Hughes Terence , Weiss Kevin , Carter James , Pan Jonathan , Paul Megan , Kim Eliott , Ramos Ezequiel , Raja Aishwarya , Barazani Sharon , Pruzan Alison , Glassberg Brittany , Skovran David , Thomas David , Meah Yasmin 
Published: May 2023

Background: We describe the implementation of a remote operational model to provide targeted, multi-faceted social services during the coronavirus disease 2019 (COVID-19) pandemic at the East Harlem Health Outreach Partnership (EHHOP), a student-run, physician-supervised free clinic (SRFC) that serves uninsurable residents of East Harlem in New York City (NYC). The model attempts to mitigate the economic consequences of the pandemic while also safely meeting the needs of patients who were quarantined or otherwise medically vulnerable.
Methods: We outline a step-by-step approach required to transition social services to a remote model, across six key workflows: (1) student volunteer recruitment, (2) fundraising, (3) grocery and financial grant allocation, (4) medication delivery, (5) mask delivery and patient education, and (6) broader community engagement.
Results: Within 20 days of the first known case of COVID-19 in NYC, we established a protocol for remote care and expanded social services. From March to July 2020, EHHOP volunteers made 221 medication and 172 mask kit no-contact deliveries. To address food and housing insecurity, 140 patients were provided financial grants and an additional 109 received food deliveries. This comprehensive response was supported through emergency fundraising efforts that generated $66,690.
Conclusions: By focusing on support for basic needs including food, medication, personal protective equipment, and patient education, EHHOP was able to bolster the safety-net for marginalized patients otherwise excluded from national economic recovery efforts and ensure continuous care for patients with chronic medical illness. EHHOP’s operational model for safe, remote delivery of social services provides other clinics with a framework to guide current and future emergency responses.
Evaluating Patient Profile, Follow-Up Rates and Barriers to Follow-Up at a Student-Run, Community-Based Tuberculosis Testing Program
Authors: Foroushani Sophia , Crawford Andrew , Woodbridge Alexandra , Frechtling Dan , Ali Juzar 
Published: May 2023

Background: The Tulane Student-Run Tuberculosis (TB) Program provides TB risk evaluation, skin testing (TST), and referrals at six homeless shelters and rehabilitation facilities. To date, there has been no evaluation of the programâ€™s patient profile. The objective of this study was to determine the symp-toms and risk factors for TB present in the program's clients, calculate follow-up rates for TST reading, and determine factors associated with an increased rate of missing reading appointments.
Methods: This retrospective chart review examines the prevalence of risk factors and TB symptoms, evaluates risk stratification, and determines barriers to follow-up for TST over a 33-month period. Rel-ative risks (RR) were calculated to determine the association between risk stratification, positive TST, and loss to follow-up. Z-values were calculated, and p-values were determined as the area of the dis-tribution outside of +/- z. P-values <0.05 were considered statistically significant.
Results: Of 6,198 individuals seen, 479 were referred to higher care, 238 received 30-day clearances, 34 deferred testing, and four were sent to the hospital. Of 5,443 TSTs placed, 4,155 were read and 214 were positive. Individuals who had any risk factors were at significantly increased risk of not attending TST reading (RR 2.14, 95% Confidence interval [CI] 1.96-2.34, p<0.01) and, for those who did attend, of having a positive TST (RR 1.52, 95% CI 1.17-1.98, p<0.01). Higher risk of no-show and positive TST was also seen in homeless individuals (RR 3.44, 95% CI 2.92-4.07, p<0.01 and RR 2.10, 95% CI 1.52-2.90, p<0.01, re-spectively) and those with intermediate-risk stratification (RR 1.25, 95% CI 1.11-1.41, p<0.01 and RR 1.32, 95% CI 1.01-1.72, p=0.04, respectively).
Conclusions: Individuals experiencing homelessness and those with intermittent TB risk stratification are at increased risk for positive TST. Both homelessness and the presence of any TB risk factors in-crease the risk of loss to follow-up.
Bridging the Language Gap in Medicine: Quality Improvement for Interpreter Services at JayDoc Free Clinic
Authors: Trieu Skyler , Bajpai Shilpika 
Published: May 2023

Background: JayDoc Free Clinic (JayDoc) is run by medical students at the University of Kansas School of Medicine. Many patients seen at the clinic have limited English proficiency (LEP) and are assisted by volunteer medical interpreters. Formal training for working with interpreters has not previously been part of JayDoc’s volunteer orientation.
Methods: An intervention emphasizing education in interpreter standards of practice, effective use of interpreter services, and culturally competent communication were presented to all incoming JayDoc volunteers (i.e., first-year medical students [MS1s]) during their volunteer orientation. Three months post-intervention a voluntary online survey was distributed to assess perceived improvement in effective interpreter partnerships and cultural communication. The survey was administered to MS1s and second-year medical students (MS2s). Responses were stratified using a two-tailed t-score distribution to analyze the impact of the educational intervention on the MS1 group in comparison to the MS2 group that did not receive the intervention.
Results: There were one hundred and five respondents (52 MS1s, 53 MS2s). MS2s had a significantly higher average number of interpreter-facilitated patient encounters (MS2 6.38; MS1 2.54; p=0.001). MS1s had a significantly higher average of perceived importance of interpreter training (MS2 4.56; MS1 4.81; p=0.031). All other survey parameters of cultural competency and interpreter-provider best practices were ranked as important by both MS1s and MS2s, without a significant difference between the responses of the two groups.
Conclusions: An educational intervention focused on interpreter-provider partnerships and cultural competency resulted in the higher perceived importance of the training session among students.
Efficacy of a Student-Run Ophthalmology Service in Managing Diabetic Retinopathy: A Five-Year Retrospective Review
Authors: He Jody , Goté John , D'Souza Haley , Barmas-Alamdari Daniel , DiSandro Giovanni 
Published: May 2023

Background:
Diabetic retinopathy is one of the leading causes of blindness in the world, and its development and progression can be prevented with appropriate glycemic control. The Health Outreach Partnership of EVMS Students (HOPES) Student-Run Free Clinic at Eastern Virginia Medical School (Norfolk, VA) provides both primary care and ophthalmology care to patients from underserved backgrounds. The purpose of this retrospective chart review is to assess whether a student-run free clinicâ€™s primary care and ophthalmology services are effective in preventing the development and progression of diabetic retinopathy.
Methods:
Inclusion criteria were a diagnosis of Type 2 Diabetes Mellitus (T2DM), two or more HOPES Ophthalmology Clinic appointments separated by at least 4 months between January 2015 and July 2019, and medical management of T2DM by the HOPES Primary Care Clinic. Objective patient data collected were HbA1c, visual acuity, and documented dilated fundus examination findings.
Results:
There were 174 HOPES Ophthalmology visits and 66 diabetic eye exam appointments in this five-year time period. The average HbA1c for patients at the initial appointment with the Ophthalmology Clinic was 7.77% Â± 1.65% and the average HbA1c at the most recent appointment was 7.4% Â± 2.28%. Among all patients, there was no statistically significant change in visual acuity in either eye from baseline to the most recent visit. There was no change in fundus examination findings in any of the patients from their initial visit to their most recent visit.
Conclusions:
The HOPES Clinic has been effective in preventing the development and progression of diabetic retinopathy in its patients who regularly follow up with both the primary care and ophthalmology clinics. This study highlights that a student-run free clinic is capable of making an impact in the community by preventing the development of a potentially blinding disease, but that further strategies to enable consistent patient follow-up are needed.
Nutrition Assessment in Student-Run Clinics Serving Hispanic/Latinx Patients
Authors: Lilja Katherine , Walters Teal , Baumler Megan Dennis , Crusan Ambria 
Published: May 2023

Background: The patients of student-run clinics, especially Hispanic/Latinx patients, are at a disproportionately high risk for chronic disease due to the negative impacts of the social determinants of health, including barriers to obtaining healthcare, ranging from lack of financial resources to fear of deportation. Nutrition services are pivotal in providing effective, holistic healthcare for this patient population seeking care at student-run clinics. The purpose of this review is to examine how nutrition assessment is conducted at student-run clinics and to determine if the nutrition assessments are culturally tailored.
Methods: Three scientific databases were searched using keywords focused on the concept of nutrition assessment in student-run clinics serving the Hispanic/Latinx population. The articles generated were reviewed by 4 independent reviewers to determine key elements related to nutrition assessment and/or nutrition services provided in student-run, free, or community clinics, with attention to addressing social and cultural barriers addressed by the clinic.
Results: A search of the literature related to nutrition services at student-run clinics yielded 3 results for nutrition assessment of the Hispanic/Latinx population in student-run, free, or community clinics. Several articles presented research on health behavioral counseling and food insecurity screening, but few studies were conducted specifically on nutrition assessment, especially for the Hispanic/Latinx population.
Conclusions: The current assessment tools have widespread use in nutrition assessment; however, they are insufficient for the distinctive characteristics of the Hispanic or Latinx population being served in a student-run clinic. Including dietetics students into a student-run clinic, if plausible, and/or a culturally sensitive guided nutrition assessment tool for students would be of benefit to adequately address the relevant social determinants of health in the nutrition assessment of patients at student-run clinics.
Barriers to Care: Improving Attendance at a Student-Run Free Psychiatry Clinic
Authors: Mause Elizabeth , Crowther Lauren , Munger Emmali , Qadri Syed 
Published: May 2023

Background: One-time clinic attendance and inconsistent follow-up are common in patients experiencing homelessness and those who access care in student-run free clinics (SRFCs). While mental health concerns are prevalent in this population, the consistent follow-up and longitudinal care necessary to improve patient outcomes has many barriers. The primary objective of this study was to assess and address the patient-identified barriers to attendance at a SRFC that operates out of a homeless shelter in Omaha, Nebraska.
Methods: Through a survey, patients indicated if one or more barriers in a list of examples had prevented their attendance in the past. This study also ascertained if patients had social support in place and reviewed demographic information. Between September 2020 and May 2021, 14 psychiatry clinics were held bimonthly with 35 different patients during which each patient was requested to complete a survey. Of the 35 requested, 13 patients completed the survey.
Results: Of the 13 patients, 62% reported at least one barrier to care. Primary barriers patients experience are forgetting appointment time (38%), feeling so poorly they don’t feel like going (31%), and having problems with transportation (31%). Although not statistically significant, there was a trend of having a case manager (OR = 0.2143, 95% confidence interval [CI] 0.0136 - 3.3698) or having at least two social support systems (OR = 0.2143, 95% CI 0.0136 - 3.3698) decreased the odds that patients would report two or more barriers to care.
Conclusions: Over half of the participants reported at least one barrier to care. Although not statistically significant, there was a trend that having a case manager and social support reduced the odds of patients reporting barriers. We suspect that creating stronger relationships with patients directly through patient liaisons and strengthening relationships with case managers will improve communication and decrease no-show rates.
Improving Equitable Access to Imaging: Developing an On-Site Ultrasound Service at a Student-Run Free Clinic
Authors: Neel Nicholas , McMillan Aislinn , Hsieh Lee , Bazzy Jimmy , Tadros Anthony , Tamayo-Murillo Dorathy 
Published: May 2023

Background: Student-run free clinics (SRFC) provide comprehensive primary care for uninsured populations throughout the country. However, imaging remains a barrier to care for underserved communities that experience inequitable access to healthcare. In this study, we describe the establishment of a radiology specialty clinic (RSC) that served as an in-house ultrasound imaging service at our institution's SRFC.
Methods: Between September 2019 and March 2020, patients were scheduled for imaging at the free clinic site, and studies were performed and read by institutional radiologists. Patient data were reviewed to assess patient demographics, study indication, ultrasound type, and time between referral and appointment. Lastly, imaging utilization was examined seven months prior to and seven months after implementing the free ultrasound clinic to assess any changes in usage, wait time, or referral patterns using Fischer’s exact test and unpaired student t-tests.
Results: A total of 10 patients were seen during the clinic’s operation, with 11 studies being performed. Overall, usage patterns stayed consistent pre and post-implementation. There was no significant difference in wait times between referral and appointment (pre-RSC 15 days vs. post-RSC 18.5 days, p=0.91) and the RSC demonstrated a total cost savings of $770 to the clinic.
Conclusions: We describe the implementation of an in-house ultrasound imaging service at our SRFC. The RSC provided increased access to imaging, demonstrated cost-savings to the SRFC, and had no negative effects on ultrasound usage or wait times between referrals and appointments.
COVID-19 Related Mental Health Among a Sample of Families Transitioning from Homelessness Living in a Communal Housing Facility
Authors: Yang Phillip , Tsai Jack , Robles-Ramamurthy Barbara , Emko Nida 
Published: May 2023

Background: The COVID-19 pandemic has worsened the health and mental health of individuals experiencing homelessness. However, little research has investigated the pandemic’s impact on families experiencing homelessness, who likely experienced greater stressors due to the additional responsibilities of managing the needs of children. Student-run free clinics (SRFCs) can provide important needs assessment investigations and mental health interventions in underserved communities. This study examined the effect of the pandemic on the mental health of one sample of families experiencing homelessness associated with an SRFC.
Methods: Between November and December 2020, families experiencing homelessness at a homeless shelter in San Antonio, Texas were surveyed. Twenty-one parent and 20 child questionnaire responses on the pandemic’s effect on health, depression, and anxiety were analyzed. One-sample t-test with Bonferroni correction was used for statistical analysis.
Results: Parents experiencing homelessness reported statistically significant worsening of coping ability, stress levels, family situation, financial situation, physical health, mental health, depression, and anxiety symptoms at the time of the survey compared to prior to the pandemic. Adults reported more worsening of anxiety symptoms than depression symptoms. Loneliness was the only general health measure that was not significantly worsened. In their young children (mean age = 6.7 years), parents reported no worsening of any outcomes.
Conclusions: Our sample of families experiencing homelessness reported significant life and mental health challenges due to the COVID-19 pandemic. People experiencing homelessness who live in a communal housing facility may protect against characteristic pandemic-related loneliness. Young children may require developmentally focused clinical assessments to adequately capture mental health challenges. SRFCs should be equipped to provide specialized mental health services and other community health services, such as vaccinations, to reduce pandemic-related morbidity and mortality.
Medical Student-Run Free Orthopaedic Clinic: Impact of Coordinator Role on Specialty Selection
Authors: Koetter Paige , Thomas Rachel , Gallo Robert 
Published: May 2023

Background: Medical student-run free clinics provide opportunities for future physicians to accrue practical experience early in their medical education. Subspecialty clinics including orthopaedics provide a unique opportunity to gain exposure to musculoskeletal anatomy and pathology. These clinics are organized and managed by a student clinic coordinator. In this study, we seek to understand the impact that being the clinic coordinator of the musculoskeletal clinic plays in specialty selection.
Methods: A descriptive study was conducted by gathering electronic survey responses from former student clinic coordinators at the Penn State College of Medicine student-run musculoskeletal clinic from years, 2009 to 2017. The respondents described the influence of the coordinator role on residency selection. Additionally, the survey consisted of a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) regarding the student’s motivation for participating in the clinic as a coordinator.
Results: From 2009 to 2017, there were 18 LionCare Orthopaedic Surgery Clinic Coordinators with a male-to-female ratio was 1.25:1. Residency specialty selection was Orthopaedic Surgery (n=8, 44.4%), Physical Medicine & Rehabilitation (4, 22.2%), Family Medicine (2, 11.1%), Cardiothoracic Surgery (1, 5.6%), General Surgery (1, 5.6%), Obstetrics & Gynecology (1, 5.6%), and Emergency Medicine (1, 5.6%). The most commonly cited reason for participation as clinic coordinator was “interest in helping an underserved population.”
Conclusions: The study illustrates an association between the role of orthopaedic clinic coordinator and entering a specialty focused on musculoskeletal care. More than half of the students who participated as a clinic coordinator pursued specialties involving musculoskeletal care (Orthopaedics and Physical Medicine & Rehabilitation). Student-run medical clinics present an opportunity to provide early exposure to musculoskeletal medicine and potential avenue for orthopaedic education and mentorship.