25 Steps to Starting a Student-Run Clinic

25 STEPS: 


1.    Identify a core group of interested students.

2.    Identify a faculty advisor.

3.    Find a community partner who is already serving the underserved in a community setting- e.g. school, church, neighborhood program, meal program.

4.    Establish a legal relationship between the university and the site so that for the purpose of medical education, the site becomes an extension of the university-Complete a memorandum of understanding or affiliation agreement.

5.     Arrange for permits as needed, environmental waste hauling, CLIA waiver, x-ray unit, etc.

6.     Contact local preceptors and community faculty if they would be willing to volunteer (from once a month to once every 3 months).

7.    Community physicians who would like to volunteer will be appointed as community faculty.

8.    Start small, perhaps one evening a week at a local community program.

9.    If possible, arrange for elective credit for the medical students.  At UCSD, first and second year medical students who want to work in the free clinic must take a required elective course, Community Advocacy, which introduces them to the free clinic.  Students who continue to be involved receive further elective credit.

10.    Initial basic supplies can usually be donated from a local practice, or the faculty practice.  Pharmaceuticals initially can be donated, and also one can use the Patient Assistance Programs.  Beginning this way requires no additional input of funds. Soon, develop a basic formulary using generics, and a mechanism to use the Patient Assistance Programs, and a wish list formulary for samples, so that patients are not being constantly switched from medicine to medicine.

11.    Consider writing a HRSA predoctoral grant to fund some faculty teaching time, especially for program supervision, AAMC grants for student community service grants, and other small grants. Over time, approach your university for funding as foundations prefer to match core funding.

12.    Empower the students, encouraging them to develop patient charts, history forms, data collection methods, an intake system, environmental waste permits, lab arrangements, social resource consultations, health education, fund-raising…”whatever it takes”.

13.    Allow some of these questions to surface over time, as the clinic evolves, questions and issues will emerge, that the students will then address, e.g. patient flow, quality assurance.

14.    Develop a mission statement and a clinic philosophy, that is reinforced and adhered to, e.g. our philosophy includes showing respect to all patients, taking time with them and establishing trust, so over time, some of their deeper problems and issues can be addressed.  Always show respect to all patients, colleagues, fellow students, custodians.

15.    Patients are seen by a pair of students, preclinical and clinical; the clinical student acts as the coach, they then present to the attending and the attending comes to see the patient, then the chart is written and signed off by both students and the attending.

16.       Develop strong social resource and case management activities at the clinic so that those patients who are eligible for access through Medi-Cal, Medicare, Medicaid, County Programs, or Healthy Families are assisted with access and are able to have a medical home. Free clinic projects should serve people who are not eligible for any access or who are unable to achieve access.

17.    Develop mechanisms to follow outcomes. A database has been developed to measure patient outcomes and compile patient statistics. The Quality of Well Being Scale is used to measure outcomes.

18.    In the summer, several students are hired to help build the infrastructure of the clinic.  We look at the clinic as a whole, brainstorm its current needs, then set goals, assign tasks, and meet weekly to review objectives and achievements.

19.    Students may do community projects and occasional research projects (Introduce concept of vulnerable populations)  at the clinic, which help to address the needs of the community and the clinic, using a COPC model of involving the community at all steps.

20.    As each site grows and becomes stronger, new sites are developed or new resources at existing sites are developed. Overall, growing deeper and stronger in terms of quality at one site is more important than developing many sites.

21.    Reach out to other professions, lawyers, pharmacists, acupuncturists, dentists to develop collaborations to address patient needs. Approach your university, local labs, purchasing cooperatives such as Council Connections, and other resources to achieve affordable lab services.

22.    Involve community members, “hanging curtains”, liaison, outreach, promotoras. Have the student see the community as their teacher and learn from community members how best to address concerns or take the next step.

23.    Maintain very high professional standards, confidentiality, quality of care, safety, not poverty or half-care because it’s the “free clinic”.

24.       Avoid hierarchical structures among the student leaders. Everyone has a leadership role, everyone works both administratively and clinically, expect a high level of maturity, responsibility, and ownership and most of all, humility. No task is too small. The clinic leaders are the ones who also take out the garbage.

25.      Practice regular reflection activities, “learning circles”, build community among everyone at the sites, learn from our mistakes, follow up, and model respectful communication, empathy, congruence, and positive regard. Practice thoroughness, conscientiousness, and compassion.