Interested in starting a student run free clinic? Start here with guidelines and advice we have!

1. Identify a core group of interested students.
— This works best when you integrate more than one health profession (Medical, Pharmacy, Nursing, Physical Therapy, Occupational Therapy, Nutrition, Health Administration, etc.)

2. Identify a faculty advisor.
— This person should be passionate about free clinic care and willing to help students set-up this process at the University. 

3. Find a community partner who is already serving the underserved in a community setting- e.g. school, church, neighborhood program, meal program.
— Community Advisory Boards are very helpful, otherwise any time of group that is integrated into the day-to-day life of your target community. Churches work well if they have weeknights open for you to go in and set up. School can work, but it is hard to find space for clinic space and may deter patients from coming in if it feels too much like a healthcare organization. This is something to talk about with your team so you keep a mutually agreeable space!

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.
— Also ensure that you have a way to insure volunteers through the University to cover them in the event of malpractice.
— Contact your school’s student involvement unit and see what options they have (if you have multiple health professions, ensure they are all covered under that legal liability).

6. Contact local preceptors and community faculty if they would be willing to volunteer (from once a month to once every 3 months).
— Community physicians who would like to volunteer will be appointed as community faculty.
— Ensure you have a way to insure all of your preceptors that do not have private insurance. A lot of times, schools have a volunteering contract that can be signed where the school will cover a volunteer in the event of malpractice. Talk with your schools volunteering department and ensure all forms of preceptors are covered (MD, PharmD, DPT, etc)

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

8. 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.
— If credits do not work then it is best to become a student organization and seek a place among the other organizations at your school to establish yourselves as a continued entity at your university. At the University of Minnesota, we are a student run organization that runs through the medical school and allows for other schools to join in the agreement. We currently have 17 different health programs enrolled in our organization.

9. 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.
— Form relationships with local medication repositories to attain medications for patients. Use GoodRx for medications we cannot get for them as needed
— For general supplies, if donations are not possible, see if you can get funding through grants and university fundraisers for your organization. Sometimes the schools will pitch in some money if you can prove the event will benefit patients/students.
— 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.

10. 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”.
— It can be helpful to assign a team lead (or 2 or 3) and give students specific roles for them to complete. Form an “Admin Board” of sorts to cover your bases. One student covering liability, another cover supplies, another covering the facility set-up, another covering preceptors, another covering integrating other health programs, etc.

11. 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.

12. 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.
— Having mission statements that showcase our drive for patient care as well as the education piece for students can help to ensure the grants are approved when applied for. Tailoring grants towards patient care and student education are 2 different routes and you can use both of those to your advantage depending on the grant.

13. 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.
— Integrate other professions as available. Pharmacy students can help better update your medication lists and get you more community options for medications and how they can be filled.
— Consider integrating PT, OT, and Nutrition services as a specialty to attract more patients to seek care and showcase the full extent of the universities specialties

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.
— It may be more beneficial to increase the amount of nights the clinic is open rather than expanding to other locations. Talk about this with your leadership team to see what may serve you best.

19. Reach out to other professions, lawyers, pharmacists, acupuncturists, dentists to develop collaborations to address patient needs (The more people, the better). Approach your university, local labs, purchasing cooperatives such as Council Connections, and other resources to achieve affordable lab services.
— This includes not only labs but an EMR
— Life is much easier with an EMR
— Pairing with a health system can be very beneficial, but sometimes they charge hefty prices.
— If your University has its own hospital or has an agreement with a hospital, look into that resource and see if they are willing to partner with you.

20. 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.
— You can include these people in decisions about what resources to add to the clinic since they will know the community well and have a good idea of what they may benefit from

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

22. 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.
— Do not be afraid to have the tough discussions with other students in leadership positions if you think there needs to be systemic change. No idea should be ignored if someone finds it important!

23. 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.

24. Practice thoroughness, conscientiousness, and compassion.