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Evaluation of the Student Volunteer Experience at

UR Well Student Outreach

**213**

Block 2, 2007

ABSTRACT

UR Well Student Outreach is a student run free clinic designed to benefit both the

uninsured it served and the volunteer students. In 2003, volunteer goals were decided. The

purpose of this project was to design and implement an evaluation of the student volunteer

experience at UR Well. The evaluation was designed with the input of the UR Well Steering

Committee and Adrienne Morgan. Key Informant Interviews were completed and a

Questionnaire was started. Interviews revealed intended goals are reached, however not equally

in all volunteer positions. Suggestions for future direction of the clinic were made. Further

development of the questionnaire will allow evaluation to be sustainable.

BACKGROUND OF PROBLEM

The number of uninsured Americans has been steadily increasing. According to the US Census

Bureau, in 2001, an estimated 41 million were uninsured. In 2006, this number had risen to nearly

47 million people.1 While precise numbers are debated, the consistent increase from year to year is

not. 2

Contrary to popular perception, the majority of uninsured in America are employed (70.7%), with

an additional 7.2% connected to the work force. Overall, more than 80% of individuals without

health insurance are part of families where at least one member works full- or part-time.

Nationally, three key reasons uninsured yet employed people cite for their lack of insurance are: no

health insurance benefits offered at the job, inability to cover the cost of premiums, and temporary

job loss. 2

Uninsured people are unable to access the same level of care as their insured counterparts. They

are more likely to delay seeking medical care, forego medical care for potentially serious

symptoms, have poorer treatment of chronic diseases and receive fewer screening services [see

figure 2].2, 3 Uninsured individuals are 4 times more likely to not have a regular care facility and

4 times more likely to use emergency room services than people with insurance. 2 Compared to

only 1 in 14 insured adults, 2 in 5 uninsured adults reported in a recent survey that they could not

see a physician when they wanted to in the last year secondary to cost. This same survey

reported that uninsured adults with high-risk conditions such as smoking, obesity, hypertension,

and diabetes were less than half as likely to access routine medical care than their insured

counterparts [see figure 4].4

Figure 2. Proportions of Adults Who Did Not Receive Appropriate Preventive Services

0

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40

50

60

70

80

90

100

Screening

Per

cen

tag

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Uninsured ≥1yInsured

Source: Ayanian, J. Z. et al. "Unmet Health Needs of Uninsured Adults in the United States."

JAMA, 284(16):2061-2069. October 25, 2000.

Figure 4. Proportions of High-Risk Adults Who Did Not Have a Routine Checkup by a Physician During the Rrior 2 years

0

10

20

30

40

50

60

Risk Factor

Uninsured ≥1y

Insured

Source: Ayanian, J. Z. et al. "Unmet Health Needs of Uninsured Adults in the United States."

JAMA, 284(16):2061-2069. October 25, 2000.

Limited access to care in turn leads to poorer outcomes. Working-age Americans without health

insurance are more likely to be diagnosed late with particularly damaging diseases such as

cancer3 or diabetes5, more likely to be hospitalized due to lack of early or preventative outpatient

treatment, receive too little medical care and receive it too late 2, 5, 6, be sicker and die sooner, and

receive poorer care when they are in the hospital even for acute situations.3 The overarching

goals of Healthy People 2010 are to increase quality and years of healthy life and to eliminate

health disparities.7 Lack of insurance clearly hinders the achievement of both of these goals.

In response to the issues facing the uninsured, free clinics have provided a safety-net of health

care. Since the 1950’s free clinics have served as private, nonprofit corporations that provide

primary and specialty care, prescription medications, and ancillary medical services. Services

are provided at little or no charge and delivered almost exclusively by volunteer licensed health

care professionals. There are over 350 registered free clinics in the United States and most of

these have started in the last two decades.8 Free clinics have been shown to reduce the

preventable hospitalization rate in the area that they serve.9

A 2001 survey of 281 clinics showed that 75% of clinics targeted uninsured patients. Fifty-five

percent had an income based eligibility criteria of 200% Federal poverty level or less. Clinics

provided a mean of 5,989 patient visits per year and 11,202 prescriptions per year to 2,311

patients.10 Because of small operating budgets, clinics rely heavily on the hours put in by

volunteers.11 The clinics surveyed were staffed on average by 156.7 volunteers and 6.9 paid

employees per clinic. In the course of one year, these surveyed clinics provided care to 650,000

patients.10 This number, however still leaves over 40 million without insurance and not covered

by these clinics.

With the number of uninsured people rising, and no systemic cure in sight, it is essential that

future doctors be trained to provide care for this population. A 2003 study looking at what

influences students to do future work with underserved populations showed that the biggest

predictor was whether the student came from a medically underserved area. Less significant, but

not fixed was whether the student had exposure to underserved populations either prior to or

during medical training.12 In addition, working with medically underserved populations during

training has been shown to reinforce ideas of non-judgmental provision of care, and increased

professional satisfaction.13 Free clinics not only provide this exposure, but have other benefits as

well. Students are able to interact with patients and see them holistically rather than

objectively.14 Evaluation of volunteer experiences at the Houston Outreach Medicine Education

and Social Services (HOMES) clinic showed that students found increased compassion and

empathy, social awareness, team work and confidence building.15

Over 30 Medical Schools across the country have developed their own free clinics to both

address the needs of the uninsured or homeless and to provide an enhanced educational

experience for the students. 15-19 Most of these clinics operate out of donated spaces that are

already accessing homeless and underserved populations such as shelters, missions and

churches.13, 20

As continued student involvement in these clinics is integral to their success and sustainability, it

is critical that the students that staff these clinics benefit as well as the patients they see.

Evaluations of student experiences at free clinics have been performed, but few are available in

the literature. The University of Washington’s Students in the Community (SITC) clinic

discussed using a previously validated measure of attitudes toward homeless.21 The University

of San Diego also discussed evaluating student experiences, but has yet to report the results or

publish the evaluation.18 Contact with other student-run free clinics around the country reveals

other groups are interested in evaluating their own volunteer programs, but few evaluation

protocols already in place.

BACKGROUND OF COMMUNITY

New York, Monroe County, and the city of Rochester are not immune to the issue of community

members lacking insurance. New York, in particular, has 2.7 million uninsured residents (14.2%)

according to 2006 US Census estimates.1 With 10% of people aged 18-64 of Monroe County

uninsured, it is better than many places in the country. When converting this percentage to

numbers, however, this comes to 45,000 individuals in the Monroe County community alone.

Like the rest of the nation, the majority (67%) of uninsured individuals are employed. The same

reasons for lacking insurance were cited in the Monroe County community as nationally. Likewise

the same pattern of increased hospitalizations, decreased access to preventative services, and

decreased access to medical care all together exists for Monroe County. In Monroe County, nearly

one in four uninsured individuals reported finding it “extremely” or “very difficult” to get medical

care when needed compared to 2% of the insured. When accessing care, people without insurance

had a greater likelihood of using the emergency room (37%) as compared to the insured (16%).

Worse yet, 43% of uninsured reported postponing needed medical care altogether. In addition,

more than three quarters of the uninsured reported being unable fill a prescription because of cost,

as compared to about one quarter of the insured.22

University of Rochester School of Medicine and Dentistry students have a strong history of

involvement in the Rochester community. Over the last sixteen years, the community outreach

program has placed over 1200 students at various agencies throughout the Rochester, providing

free school physicals, supporting patients in the hospital, tutoring for inner-city school children,

among other activities. In 2003, the idea was born of expanding these opportunities and

addressing the needs of the uninsured in our own community in the form of a student-run free

clinic.

A core group of students under the direction of Adrienne Morgan attended conferences, visited

other free health clinics, researched clinic staffing structures, and surveyed the Rochester

community to better understand what needs were not being addressed. The Southwest Area

(SRA) of Rochester was found to have particular need. In 2000, this area was home to 19,774

individuals. The median income of homes in this area was $20,582 compared to $27,123 in the

city as a whole and $44,891 in the county. Thirty-three percent of households were mothers

caring for children alone compared with 23% in the city. Although there is no specific data for

the SRA, based on the median income for the area, one could classify many in SRA as "working

poor." This population would benefit from the services of a free clinic that was open during

traditionally non-working hours. With the gathered information and experiences, a model and

plan for Rochester’s first student-run free clinic operating in this neighborhood of Rochester was

developed. 23

The core group expanded in the winter of 2003 to form a steering committee consisting of

several teams: clinical coordinator, administrative coordinator, student volunteer coordinator,

physician volunteer coordinator, referrals, pharmacy, financial director, clinic director, statistics

and public relations. In spring 2004, the steering committee partnered with St. Joseph’s

Neighborhood Center, a health center operating near the Southwest neighborhood, to use their

facilities on Tuesday nights. The clinic opened its doors on September 14th, 2004 with the

mission of “providing free, high quality health maintenance and preventive services to local

uninsured families and individuals in an effort to foster the health of the Rochester community,

while promoting the spirit of education, social justice and collaboration.” 23

While the steering committee still organizes and guides the clinic, it is the student and physician

volunteers that come each week that allow the clinic to run. The volunteer model of the clinic

[see figure 1] is based on the New York City Free Clinic implemented by New York University

School of Medicine.19 It consists of a front desk team who checks the patient in and out, a

medical assistant who takes vital signs and puts the patient in the room, a health team of a second

year medical student and a fourth year medical student who sees the patient, an administrative

coordinator who works at the front desk to manage logistics and a clinical coordinator who

works with the health teams to answer questions and facilitate the evening. The health teams

report to a volunteer physician and discuss the plan for the patient. Referrals made on the clinic

night are followed up by a separate volunteer who comes in during the week. The model was

chosen to provide the best educational experience to the volunteers while still providing high

quality health care to the patient.

Figure 111

Clinic Logistics

Front Desk Two 1st Year Students

Waiting Area Health Education &

Statistics

Medical Assistant One 1st Year Student

Vitals & Chief Complaint

Team C One 3rd or 4 Year Student

One 2nd Year Student

Team B One 3rd or 4 Year Student


Team A One 3rd or 4 Year Student


Volunteer Physician One licensed doctor confirms exam findings and

collaborates with students concerning: Medications Laboratory Work Specialty Referrals Diagnostic Tests

Administrative Coordinator One 2nd year student answers questions from the front desk,

draws labs, and oversees management of medical records

and information transfer

Clinical Coordinator One 4th year student who answers questions from the health teams

or the physician, draws labs, assists with referrals, and

provides continuity of care

Under this model, the following goals for the student volunteer experience were laid out.

Opportunity for hands-on medical education and knowledge application of principles and

skills learned throughout the medical curriculum

Improved awareness of the insurance disparity as a public problem

Opportunity to apply human faces to the staggering numbers of uninsured persons

Opportunity to appreciate the importance of cost effective medical decisions and

treatment plans

Exposure to an inner-city primary care health center

Inspire future physicians to consider entering a career with significant attention to the

care of medically underserved populations

Provide a unique and important outlet to students seeking an opportunity for direct

medical service to an underserved population

Maintain medical student interest in social justice, primary care, and the underserved

Exposure to the financial and human management of medical services

Experience in teaching

In a clinic that would be sustainable across the years.23

As discussed above, student volunteers are the substance of the clinic and ensuring and enriching

experience is vital to the continuation and growth of the clinic. The clinic thus far has been very

successful and student interest continues to be high. Students are recruited as first years at the

Community Involvement Fair at the beginning of the first year as well as with informational

meetings. Students are recruited via email, as well. Current interest has exceeded the number of

volunteer positions available with 42 interested first years in a lottery for only 12 slots.

Maintaining this interest to staff free clinics over time can be challenging.24 Discussions of

expanding the clinic to include an additional night or provide other services are on the table. 25

This, naturally, would require more involvement by the student volunteers. As UR Well Student

Outreach looks to the future of expanding the hours of the clinic and the resources that clinic

offers, it is essential that the experiences of our volunteers are understood. The evaluations

previously performed and documented as discussed above do not pertain to our population of

patients and our model of healthcare. Thus, to evaluate our system, there is a need to develop a

tool to do so.

PROJECT DESCRIPTION AND METHODS

The purpose of this project was to develop and implement a program evaluation of the student

volunteer experience at UR Well, to determine whether or not the students are reaching the

intended goals, what other benefits they may be getting, and what improvements can be made.

The specific type of evaluation depends on the framework used to define the program. If

considering UR Well as a whole, the student volunteer portion of the project is part of the

process and this could be considered a process evaluation. If looking at specifically the student

volunteer aspect of the program, this is an evaluation of the impact of the program on the

students.

The framework for the design of this program evaluation was derived from the Centers for

Disease Control Evaluation Working Group. For any program evaluation designed, for it to

adhere to the standards of utility, feasibility, propriety, and accuracy, following the steps laid out

in figure 3 are recommended.26

Figure 326

This evaluation was developed and implemented through the basic steps of Engaging the

Stakeholders, Describing the Program, Focus the Evaluation Design, Gather Credible Evidence,

Justify Conclusions, Ensure Use and Lessons Learned. This section will address the first 5 of

these steps.

Engaging the stakeholders is necessary in order to ensure that results of the evaluation will be

useful and pertinent to the program being evaluated. The stakeholders in this case are the

steering committee and the director of the clinic who guide the future directions of the clinic.

They were notified of this project at its inception and asked to give input as to what should be

included in the evaluation. Other stakeholders are the student-run clinics across the country that

may also be either looking for a method to evaluate their programs or may have input as to their

own experiences with evaluation.

Describing the program delineates the strategies and goals of the clinic and is the foundation for

the content of the evaluation itself. This aspect of evaluation development was completed by

researching the history and initial proposal of UR Well Student Outreach as detailed in the

community background section.

In the design of the evaluation, six aspects should be considered—purpose, users, uses, methods,

questions, agreements. The purpose of this evaluation was two-fold—to assess the effects of the

volunteer program on the volunteers, and to determine if there are areas of the program that need

change. The users of the evaluation are the UR Well Student Outreach Steering Committee, and

the faculty director of the project. The evaluation will be used to optimize the student volunteer

experience. Due to time constraints, the initial evaluation was done using key informant

interviews with concurrent development of a questionnaire that could be more widely

distributed. The questions for both the key informant interviews [Appendix A] and the

questionnaire [Appendix B] were developed using the stated goals for volunteers as the

backbone. These were both sent to the stakeholders for their input for content and readability.

The final question sets were piloted (for key informant interviews) and will be pre-tested and

piloted (for questionnaire) prior to administration.

Gathering credible evidence is essential to the use of the results of the evaluation being created.

Indicators, sources, quality, quantity, and logistics are all aspects of evidence gathering. The

indicators of this evaluation were the goals stated for volunteers at the inception of the clinic as

described in the community background section. For both the key informant interviews and the

questionnaire, the source of respondents is a pool of 107 current and past volunteers at UR Well

Student Outreach. Respondents for the key informant interviews were selected to represent the

five volunteer positions (Health team senior, health team junior, front desk, medical assistant,

referrals) and when available, were people who had volunteered 3 or more times in that

particular position. The key informant interviews also included two interviews with physicians

who had precepted at the clinic since the clinic’s inception. The overall goal was to have 2-3

interviewees per position with 12-15 interviews total. The questionnaire will be offered to all

current and past volunteers at UR Well Student Outreach who are currently enrolled at the

University of Rochester School of Medicine and Dentistry. This number will allow a more

complete look at the experiences of the volunteers. Because the evaluation is concerned with

determining the subjective experiences of the volunteers, having volunteers as sources for the

data collected is reliable, valid, and appropriate.

Logistics: Key informant interviews: Twice the number of needed respondents were contacted

via email and invited to a 20-30 minute interview either in person or on phone. The purpose and

voluntary nature of the interview were explained in the email. Interviews were set up and data

was collected either by note taking during the interview and then adding to notes immediately

after the interview was complete. All notes taken during the interviews were taken on a word

processor and files were saved with no identifying information.

Questionnaire: Subjects recruited will be the 107 current and past volunteers at UR Well Student

Outreach who are currently enrolled at the University of Rochester School of Medicine and

Dentistry. They will be recruited by email which will include the purpose as well as the

voluntary nature of the study. The survey [see Appendix B] will be finalized, pre-tested, then

piloted with a group of 10 volunteers to enhance validity prior to distribution to the entire group.

After piloting, the survey will be distributed via email. As the study will be exempt, consent will

be assumed by individuals who complete and return the survey. No identifying information will

be collected on the survey itself. Responses will be returned via email to the PI of the study.

Because the results of the questionnaire may be published in a peer reviewed journal in the

future, RSRB approval is required. The protocol is found in appendix C.

PARTNERSHIPS

The significant partnerships I developed were with the stakeholders for this evaluation. I met

with Adrienne Morgan, the faculty director of UR Well prior to the CHIC Clerkship to discuss

the possibility of an evaluation. The members of the Steering Committee for UR Well were

contacted by email. They received initial copies of the evaluation and added their comments

about what the key informant interviews and questionnaire should include.

Having not done key informant interviews, I partnered with Hemant Kalia, MD, MPH through

class discussions to get his guidance in designing and implementing the interview.

As there is no directory of student-run free clinics available, those with websites were found by

searching for student-run free clinics on www.google.com. Some clinics had links to others and

these were followed, as well. The list in Appendix D was created and the volunteer coordinators

of the clinics were contacted and asked if they had performed evaluations of their volunteer

programs before and if they had developed any tools. I heard back from 4 of these contacted

clinics. While they had not had conducted evaluations themselves, they were interested in any

evaluation created.

IMPLEMENTATION

Key Informant Interviews: The key informant interviews were developed as outlined above.

Overall interest in the project was very good. Interviews were scheduled during the second and

third weeks of the block either in person or over the phone depending on the volunteer’s

availability. In the end, 2 physicians, 3 Health Team Senior volunteers, one of whom had also

served as a medical assistant, Health Team Junior volunteers, one referrals volunteer, one front

desk volunteer, and one medical assistant were interviewed. The remaining referrals and front

desk interviews were unable to be scheduled due to time constraints and scheduling conflicts.

The results of the interviews were compiled and will be distributed to the members of the

steering committee.

Questionnaire: The questionnaire, likewise, was developed as outlined above. Originally, it was

hoped that a previously validated measure could be found either in the literature or from other

student-run free clinics. Neither of these was found, however, and it became necessary to

develop a measure specific to our project. A protocol was developed and submitted to the

RSRB. This process took until the beginning of the third week of the block. Knowing that

RSRB approval, even for exempt studies can take up to two weeks, it was planned that the

questionnaire would have RSRB approval/exemption and be taken to the pre-piloting phase by

the end of the block. This goal was attained.

SUSTAINABILITY

The sustainability in this project lies in the questionnaire and the development of a less time

consuming method of volunteer evaluation than key informant interviews. What remains to be

done is finalizing, pre-testing, piloting, and administering the final questionnaire. The

questionnaire should then be given at regular intervals in order to monitor the student

experiences. Consideration should be made for the balance of not overloading the student

volunteers with multiple surveys, but at the same time ensuring that volunteers at all levels are

being surveyed. This could be accomplished by having the clinical schedulers send the

questionnaire out to all of the volunteers who participated in a particular block. This would

ensure that all levels of volunteers will get the survey and the survey would be administered in

proximity to the volunteer experience for better recall. In addition, if it were a part of the duty of

clinic schedulers, it would be passed on year to year to the upcoming scheduler and would easily

be sustained

RESULTS/DISCUSSION/RECOMMENDATIONS

The interviews were well received by the stakeholders, students, and physicians. Response rate

was limited by time and scheduling rather than number of interested respondents. As outlined

above there were 11 people involved in total, 2 physicians, 3 Health Team Seniors, 3 Health

Team Juniors, 1 Referrals, 1 Front Desk, and 1 Medical Assistant. One of the Health Team

Seniors had been both HTS and Medical Assistant. The estimated range of nights volunteered in

this group was 2-10+ nights. All respondents said they would volunteer again in the future.

Other experiences the student volunteers had providing direct medical care to underserved

communities consisted of Emergency Medicine rotations, ambulatory preceptorships at Anthony

Jordan Health Center, the homeless bus, providing school physicals, and volunteering at St.

Joseph’s Neighborhood Center. Future career choices represented were Neurosurgery,

Cardiology, Psychiatry, Internal Medicine/Primary Care, Ob/Gyn, Dermatology, Pediatrics, and

undecided. The respondent going into primary care cited work at UR Well as contributing to

that desire. All respondents reported that they wanted to work in some function with

underserved populations in the future. Three specifically stated that their future practice would

be mainly underserved populations. These three stated that they had this interest prior to

volunteering, but that working at UR Well had fostered the desire.

Common themes that arose during the interviews were A) Volunteers gained exposure to

working with underserved communities in a unique outlet not necessarily available otherwise; B)

Working at UR Well put faces to the numbers of uninsured people in the US and broke

previously held stereotypes of this population; C) Working at UR Well provided an opportunity

for students to apply knowledge, skills and principles learned in class; D) Volunteers developed

an appreciation for delivering healthcare while being cognizant of financial restraints. These

themes, each discussed by a majority of respondents, are all aspects of the intended goals for

student volunteers. [See Appendix E for full compilation of responses]

Taken as a whole group, all of the goals stated at the inception of the clinic have been attained.

This was not true on an individual basis, however, and benefits were skewed toward health team

juniors and seniors who had direct contact with both the patient and the physician. Front desk,

medical assistant, and referrals volunteers, while not getting experiences such as an opportunity

to appreciate the importance of cost effective medical decisions and treatment plans or an

experience teaching had more experiences with the administrative side of health care. An

argument can then be made that the best way to achieve the goals for each volunteer would be to

serve in different positions over time.

Through the suggestions of students and through evaluating student responses, the following

recommendations for the volunteer program of UR Well Student Outreach could be made:

Increase front desk and medical assistant interaction with the physician—both Health

Team Juniors and Seniors reported that the physician helped them through teaching and

observation, however front desk, medical assistant, and referrals volunteers had little to

no interaction with the physician. Their experiences could be benefited by increasing this

interaction in some way.

Increase efficiency of the evening—when asked about what could be changed to improve

UR Well, efficiency was a consistent answer. This is improving over time as supported

by the physicians’ responses and many of the volunteers had their experiences one or two

years ago. It is likely that the clinic they would work at today is already more efficient

than when they first volunteered. Because it was a consistent response, however, it

warrants consideration.

Increase volunteer opportunities—the group was split about how the volunteer nights are

scheduled. Some wanted a more longitudinal experience available, some wanted few

nights close together and some wanted few nights spread apart. The front desk volunteer

appreciated the longitudinal nature of the position. Most agreed that all who were

interested in volunteering should be given a chance and that this took precedence over a

few people having more experience. Ideas for increasing these opportunities were

through homeless outreach, other specialty clinics, and by adding a second night.

Have a list of specialist resources available for health teams and physicians to know what

is possible. Putting the list on a computer would allow the list to be easily changed as

resources change.

Send an email out to physician volunteers the week prior to their scheduled night to

confirm that they are working.

Have specific email addresses for all members of the steering committee that would stay

the same year to year even as the person changed. This would be especially helpful for

the physician volunteer coordinator.

Post a list of the names, faces, and roles of the steering committee at St. Joseph’s

Neighborhood Center so volunteer physicians know who the key players are.

Despite having suggestions, the volunteers overall had very positive experiences at UR Well and

were pressed to find something to improve on. They felt that their education was enhanced by

the time they gave. These responses are supportive of moves toward expanding the capacity of

UR Well. Any expansion would necessitate more volunteer involvement—either more sessions

by the same volunteers, or more volunteers total. With the benefits the interviewees spoke of,

either of these options would add to the University of Rochester student’s experience.

It must be noted that the above findings reflect the opinions of a small number of the total

volunteers at UR Well. These opinions were elicited from these particular volunteers because of

their greater than average experience volunteering and thus, while more knowledgeable about

their positions, they would also be more likely to have had positive experiences at the clinic as

they continue to volunteer. In the future, a more objective measure given to a wider range of

volunteers would be beneficial to obtain a better representation of the volunteer experience as

previously discussed.

Stepping out of the UR Well community and back into the larger community of student-run free

clinics, while I was attempting to contact other clinics about their methods of evaluation, I noted

that there was no central gathering place for students with questions about free clinics to turn to.

I would highly doubt that as few clinics have evaluated their volunteer experience as reported.

Had there been a forum for student run clinics, I might have been able to discuss this project and

obtained other peoples ideas and advice. Similarly, after the completion of this project,

dissemination of my experience in the process would be much easier. A future direction for

someone interested in working with the student-run free clinic community would be to create a

forum where issues that face free clinics across the country could be discussed the wheel would

not have to be reinvented at every medical school across the country.

IMPACT SECTIONS

Project Impact: The impact of this project will be determined by what follows the results. It

will be up to the steering committee to decide whether they want to incorporate any of the

suggestions. Some of them are small details that are easily provided (i.e. list of steering

committee members) and some are already in progress (expansion of specialty clinics and second

night of clinic). Key informant interviews are time consuming and for a group that is already

donating a significant amount of time to the free clinic, having a measure that is easier to

administer would likely be more sustainable in the future.

Personal Impact: Prior to completing this project, my future career goals included working with

underserved communities on a long term basis. I feel strongly that it is my role as a physician to

improve the health of all members of my community. Completing this project taught me a

number of skills that I have not had before. First and foremost was the method of program

evaluation. Following the steps outlined by the Centers for Disease Control Evaluation Working

Group, I was able to complete one evaluation and start another. The steps are general enough

that they can be applied to any type of program that requires evaluation. As I look toward

working with underserved populations in the future, I am almost certain that I will be creating

programs to improve health care access. In addition, through this project, I have had concrete

experience developing two types of evaluations, key informant interviews and a questionnaire.

Having these program evaluation skills will be vital in assessing if what I create is helpful.

As part of understanding community health programs, I also researched methods of community

intervention. Having even this small background is a foundation for starting community

programs in the future. I have had thoughts of getting a degree in public health in the future, but

seeing the tools that I might learn in a public health class has convinced me that further studies in

this area will behoove the future communities I work in.

This project also gave me experience in putting protocols through the RSRB. While I have had

experiences with this before, this is the first protocol I have put through on my own. Questions

that were answered along the way will help me in the future as additional studies will need to be

put through.

LONGITUDINAL EXPERIENCES

The majority of my volunteer work has been with UR Well Student Outreach. I came on board

the Steering Committee in 2004 as the Student Volunteer Coordinator. I was involved in the

initial development of the clinic in terms of developing the clinic goals and structure, choosing a

site, recruiting, training, and scheduling volunteers. I also served as a health team junior,

referrals volunteer, and health team senior. My role on the steering committee ended in June of

2005, but I have continued to volunteer at the clinic. Doing this project has been an excellent

way to be more involved with the clinic. In addition, it is encouraging to see that many students

have had very positive educational experiences through the opportunities that the UR Well

Student Outreach offers.

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8. Free Clinic Foundation of America. Available at: http://www.freeclinicfoundation.com.


9. Epstein AJ. The role of public clinics in preventable hospitalizations among vulnerable

populations. Health Serv Res. 2001;36:405-420.

10. Nadkarni MM, Philbrick JT. Free clinics: A national survey. Am J Med Sci. 2005;330:25-

31.

11. Geller S, Taylor BM, Scott HD. Free clinics helping to patch the safety net. J Health

Care Poor Underserved. 2004;15:42-51.

12. Tavernier LA, Connor PD, Gates D, Wan JY. Does exposure to medically underserved

areas during training influence eventual choice of practice location? Med Educ. 2003;37:299-

304.

13. Fournier AM, Perez-Stable A, Greer PJ,Jr. Lessons from a clinic for the homeless. the

camillus health concern. JAMA. 1993;270:2721-2724.

14. Davenport BA. Witnessing and the medical gaze: How medical students learn to see at a

free clinic for the homeless. Med Anthropol Q. 2000;14:310-327.

15. Clark DL, Melillo A, Wallace D, Pierrel S, Buck DS. A multidisciplinary, learner-

centered, student-run clinic for the homeless. Fam Med. 2003;35:394-397.

16. Wilde MH, Albanese EP, Rennells R, Bullock Q. Development of a student nurses' clinic

for homeless men. Public Health Nurs. 2004;21:354-360.

17. Moskowitz D, Glasco J, Johnson B, Wang G. Students in the community: An

interprofessional student-run free clinic. J Interprof Care. 2006;20:254-259.

18. Beck E. The UCSD student-run free clinic project: Transdisciplinary health professional

education. J Health Care Poor Underserved. 2005;16:207-219.

19. Lopez G. New york city free clinic: Overview of operations .

20. Steinbach A, Swartzberg J, Carbone V. The berkeley suitcase clinic: Homeless services

by undergraduate and medical student teams. Acad Med. 2001;76:524.

21. Lester HE, Pattison HM. Development and validation of the attitudes towards the

homeless questionnaire. Med Educ. 2000;34:266-268.

22. Survey of Health Care Coverage and Access in Monroe County. Available at:

http://www.harrisinteractive.com/news/downloads/2001_FingerLakesCharts_News.PDF.


23. Baidoo N, Baker B, Camenga D, Ebede T, Dhakal S. Family health center: A proposal by

the steering committee. 2003.

24. Fleming O, Mills J. Free clinics in north carolina: A network of compassion,

volunteerism, and quality care for those without healthcare options. N C Med J. 2005;66:127-

129.

25. Wenger J. UR well: Expanding coverage, increasing opportunities. 2006.

26. Centers for Disease Control and Prevention. Framework for program evaluation in public

health. MMWR. 1998;48:RR-11.

Appendix A: Key Informant Interview Questions

Tell me about your experience volunteering at UR Well Student Outreach.

What volunteer positions have you held? How many nights have you volunteered? What were your reasons for volunteering? Will you volunteer again?What is your opinion of the structure of the volunteer positions? What other experiences during medical school have you had providing direct medical

care to an underserved population? Working in the inner-city?

What are the benefits and drawbacks to working at UR Well?

What did you gain from volunteering? Any aspect of the volunteer experience that you did not like? Any aspect you think could have been better?

In what ways did you learn from your time at UR Well?

What principles and skills from the classroom could you apply? (PEx, clinical reasoning, sensitivity to culture)

How did the physician contribute to your education? Did you have an opportunity to teach?

In what ways, if any, did you gain exposure to the administrative, financial and human management aspects of medicine?

In what way working at UR Well changed your awareness of insurance disparities? What particular patients or experiences stand out in your mind? In what way did the financial situation of the patient play a role in your decision and

treatment plan?

What career are you considering following?

In what way, has your work at UR Well influenced this? Attitude toward working with underserved populations in the future?

Influenced by UR Well?

If you were given a chance to change one thing in the system here what would you do which will be beneficial for the future volunteers?

Anything else you would like to tell me that I did not ask about?

Thank you very much for your time. Your experiences and insights are very helpful to us. The information from the interviews will be compiled by the end of this month. Would you like to receive any follow up information upon its completion?

Appendix B: Candidate questions submitted to RSRB for final questionnaire

Please check the positions you held and list the year you held them:

Front Desk MS year: Medical Assistant MS year: Health Team Junior MS year: Health Team Senior MS year: Referrals MS year:

How many total hours have you volunteered at the clinic?

Patient contact :During each year, how many patients did you see per night? Were you satisfied with the amount of patient contact? Was the amount of patient contact worth the time you spent volunteering?Did you feel as though you had a sufficient amount of time to care for your patients?

Enrichment of education:Did you have any experiences at the clinic that you might not otherwise have had?Did you learn while you were at the clinic?As a first or second year were you able to apply what you have learned thus far in your medical education? In what way?As a third or fourth year were you able to apply your medical education at the clinic? In what way?How did the physician contribute to your education?Did you meet physicians that you might not have otherwise met?

Exposure to every aspect (administrative, financial, health management) of health careDid you deal with any of the following aspects of health care of while working at UR Well?

Check-in, Check-out, Laboratory, Laboratory paperwork, Scheduling, Follow up, Referrals, Insurance/Medicare/Medicaid, Prescriptions

What was your level of understanding of the aspects of running a clinic prior to volunteering?What was your level of understanding of the aspects of running a clinic after volunteering?

Opportunity for hands-on medical education and knowledge application of principles and skills learned throughout the medical curriculumWhat principles or skills that you learned in your medical education did you apply to your work at UR Well? (eg biopsychosocial model, techniques learned in class)What skills did you utilize at UR Well? Patient interviewing; Physical Exam; Vital signs; Blood draw; PPD; Urinalysis; EKG; Blood glucose; I & D

Improved awareness of the insurance disparity as a public problemWhat was your level of awareness of the problem of lack of medical insurance prior to volunteering?What was your level of awareness after volunteering?

Were there any experiences in particular that influenced your awareness of insurance disparity as a public problem?

Opportunity to appreciate the importance of cost-effective medical decisions and treatment plans by more carefully considering their effects on patientsHow often was cost a factor in your treatment plan?Was your treatment plan ever altered based on the patient’s ability to pay?If so, how often?What was your level of understanding of costs of healthcare prior to volunteering? After?

Appendix B: Candidate questions submitted to RSRB for final questionnaire

Exposure to an inner-city primary care Health CenterPrior to working at UR Well, had you worked or volunteered at a primary care health center?Are you aware of any other opportunities to provide direct medical service to an underserved population? Have you taken part in any of these?

Inspire future physicians to consider entering a career with significant attention to the care of medically underserved populations Prior to working at UR Well, were you considering a career with significant attention to medically underserved populations? Has working at UR Well changed this?If there was a change, to what do you attribute the change?

Maintain medical student interest in social justice, primary care, and the medically underservedPrior to working at UR Well, were you interested in social justice? Has working at UR Well changed this?If there was a change, to what do you attribute it?Prior to working at UR Well, were you interested in primary care? Has working at UR Well changed this?If there was a change, to what do you attribute it?

Preparation for teachingDid you have an opportunity to teach your fellow students? While serving what role?Did you have an opportunity to teach your patients? While serving what role?

Building relationships with a community-based organizationPrior to working at UR Well, had you done work with St. Joseph’s Neighborhood Center?After working at UR Well, have you done work with St. Joseph’s Neighborhood Center?If so, did your volunteering at UR Well play a role?

GeneralOverall, how would you rate your experience?1: not worth my time……………………………………………..10: Worth Every MinuteWhat were the benefits you received from working at UR Well?What were negative aspects of working at UR Well?Was there anything that could have been done differently?Will you volunteer again? If yes, why? If no, why not?

Appendix C: Protocol for RSRB Exemption Approval

Evaluation of the Student Volunteer Experience at UR Well Student Outreach

I. PURPOSE OF THE STUDY AND BACKGROUNDPurpose of the study: The purpose of this study is to develop and implement a survey to determine the benefits and areas needing improvement of the student volunteer program at UR Well Student Outreach.

Background: University of Rochester School of Medicine and Dentistry students have a strong history of involvement in the Rochester community. Over the last sixteen years, the community outreach program has placed over 1200 students at various agencies throughout the Rochester, providing free school physicals, supporting patients in the hospital, tutoring for inner-city school children, among other activities. In 2003, the idea of expanding these opportunities to include a student-run free clinic was born. A core group of students under the direction of Adrienne Morgan attended conferences, visited other free health clinics, researched clinic staffing structures, and surveyed the Rochester community to better understand what needs were not being addressed. With the gathered information and experiences, a model and plan for Rochester’s first student-run free clinic was developed1.

The core group expanded in the winter of 2003 to form a steering committee consisting of several teams: clinical coordinator, administrative coordinator, student volunteer coordinator, physician volunteer coordinator, referrals, pharmacy, financial director, clinic director, statistics and public relations. In spring 2004, the steering committee partnered with St. Joseph’s Neighborhood Center, a health center operating in the Southwest neighborhood, to use their facilities on Tuesday nights. The clinic opened its doors on September 14th, 2004 with the mission of “providing free, high quality health maintenance and preventive services to local uninsured families and individuals in an effort to foster the health of the Rochester community, while promoting the spirit of education, social justice and collaboration.”1

While the steering committee still organizes and guides the clinic, it is the student and physician volunteers that come each week that allow the clinic to run. The volunteer model of the clinic (see below) is based on the New York City Free Clinic implemented by New York University School of Medicine.4 It consists of a front desk team who checks the patient in and out, a medical assistant who takes vital signs and puts the patient in the room, a health team of a second year medical student and a fourth year medical student who sees the patient, an administrative coordinator who works at the front desk to manage logistics and a clinical coordinator who works with the health teams to answer questions and facilitate the evening. The health teams report to a volunteer physician and discuss the plan for the patient. Referrals made on the clinic night are followed up by a separate volunteer who comes in during the week. The model was chosen to provide the best educational experience to the volunteers while still providing high quality health care to the patient. [See appendix C of final paper]Under this model, the following goals for the student volunteer experience were laid out:

Opportunity for hands-on medical education and knowledge application of principles and skills learned throughout the medical curriculum

Improved awareness of the insurance disparity as a public problem Opportunity to apply human faces to the staggering numbers of uninsured persons Opportunity to appreciate the importance of cost effective medical decisions and treatment plans Exposure to an inner-city primary care health center Inspire future physicians to consider entering a career with significant attention to the care of medically

underserved populations Provide a unique and important outlet to students seeking an opportunity for direct medical service to an

underserved population Maintain medical student interest in social justice, primary care, and the underserved Exposure to the financial and human management of medical services Experience in teaching

In a clinic that would be sustainable across the years.1


Student volunteers are the substance of the clinic and ensuring and enriching experience is vital to the continuation and growth of the clinic. The clinic thus far has been very successful and student interest continues to be high. Maintaining volunteer interest to staff free clinics over time can be challenging.3 Discussions of expanding the clinic to include an additional night or provide other services are on the table.5 This, naturally, would require more involvement by the student volunteers. As UR Well Student Outreach looks to the future of expanding the hours of the clinic and the resources that clinic offers, it is essential that the experiences of the volunteers are understood.

Search of the literature about evaluation of volunteer programs and in particular volunteer experiences at student run free clinics is sparse. A preliminary, unpublished study of attitudes of student volunteers toward working in underserved populations has been mentioned in the literature but not published to date.2 Contact with other student-run free clinics around the country reveals other groups are interested in evaluating their own volunteer programs, but no evaluation protocols already in place. A need exists to develop a tool to evaluate the volunteer experience specifically for the student volunteers at UR Well, but also a tool that could be used by other student-run clinics.

II. CHARACTERISTICS OF THE RESEARCH POPULATIONThe total number of expected respondents will be 75, approximately 30% male and 70% female in line with the population of volunteers at UR Well Student Outreach. Respondents will all be over the age of 18 years. There will be no restrictions on the basis of race or ethnic origin. Inclusion criteria will be enrollment at the University of Rochester School of Medicine and Dentistry and past or present involvement as a volunteer at UR Well Student Outreach. Respondents will only be excluded if they do not fit inclusion criteria. No vulnerable populations will be involved.

III. METHODS AND PROCEDURESProcedures: The format of this study will be a community survey of the population of student volunteers at UR Well Student Outreach. There are 107 active and past volunteers at UR Well currently enrolled at University of Rochester School of Medicine and Dentistry. The survey [see Appendix G of final paper] will be piloted with a group of 10 volunteers to enhance validity prior to distribution to the entire group. After piloting, the survey will be distributed via email. No identifying information will be collected on the survey itself. Responses will be returned via email to the PI of the study. Data Storage and Confidentiality: The volunteer responses will be saved onto a password-protected hard drive. No identifying information will be kept. Any emailed copy of the response will be permanently deleted from the PI’s mailbox. Data responses will be collated into a spreadsheet containing no identifying information. This spreadsheet may be used by members of the steering committee of UR Well Student Outreach. Data Analysis: Descriptive statistics will be used to summarize the data received. Chi square analyses, ANOVA, and t-tests will be used where appropriate. Publication: The PI reserves the right to publish the survey and the data obtained in the survey in a peer-reviewed journal.

IV. RISK/BENEFIT ASSESSMENT1. Risk Category: Minimal2. Potential Risk: None3. Potential Benefits to the Subjects. Improvement of the UR Well Student Outreach Volunteer Program to better serve their needs

V. SUBJECT IDENTIFICATION, RECRUITMENT AND CONSENT/ASSENT1. Method of Subject Identification And Recruitment: Subjects will be recruited through email solicitation of those who are actively volunteering or who have volunteered in the past at UR Well Student Outreach.2. Process of Consent: As this is an exempt study, written consent will not be required. The initial recruitment email will be an information letter that will describe the nature of the survey and detail that the study is entirely voluntary.


Sources Cited

1. Baidoo N, et al. Free Family Health Center: A Proposal By the Steering Committee. Unpublished proposal. 2003.

2. Beck E. The UCSD Student-Run Free Clinic Project: Transdisciplinary Health Professional education. Journal of Health Care for the Poor and Underserved. 2005; 16: 207-219.

3. Fleming O, Mills J. Free clinics in North Carolina: a network of compassion, volunteerism, and quality care for those without healthcare options. North Carolina Medical Journal. 2005; 66: 127-129.

4. Lopez G. New York City Free Clinic: Overview of Operations [Presentation]. Medical Student Run Free Clinic Conference at New York University. 2004.

5. Wenger J. UR Well: Expanding Coverage, Increasing Opportunities. Unpublished Report. 2006.

Appendix D: Partners

1. Hemant Kalia, MD, MPH Resident General Preventative Medicine/Public HealthDepartment of Preventative and Community Medicine270-223-6078 [email protected]

2. Adrienne Morgan Director, CACHEDUniversity of Rochester School of Medicine and [email protected]

3. UR Well Student Outreach Steering Committee

Name RoleEmail Address

Zachary Borus Clinic Director globalJanaki Nathan Referrals globalKarim Boudadi Referrals globalDomenic Roma Clinic Coordinator globalTracy Fuller Clinic Coordinator globalAllison Panzer Clinic Coordinator globalAnnabel Fu Administrative Coordinator globalKristopher Denby Administrative Coordinator globalAshley Poelma Administrative Coordinator globalAshley O'Hara Administrative Coordinator globalKeri Allen 2nd yr Clinic Scheduler globalJacqueline Zayas 4th yr Clinic Scheduler globalPatrick Francis Fundraising/Finance globalAnnabelle de St. Maurice

MD Recruitmentglobal

Kate Diaz Stats globalKate Diaz Pharm globalAleksey Tentler Public Relations/Website globalSummer Chapin At Large globalJessi Kaur At Large globalJesse Wenger At Large globalNikki Burr At Large global

mailto:[email protected]


Appendix D: Partners

4. Student Run Clinic Contacts

School Clinic Name Volunteer Contact info WebsiteUCSD UCSD Free Clinic Project [email protected] http://meded.ucsd.edu/freeclinic/services.htmlMSSM EHHOP http://eastharlemhealth.orgCornell http://wccc.med.cornell.edu/Einstein ECHO http://www.echo-clinic.org/index2.php?page=volunteers.phpColumbia CoSMOStanford Arbor Free Clinic http://pacific.stanford.edu/NYU NYC Free Clinic http://www.med.nyu.edu/nycfreeclinic/contact/contact.htmlUC Davis Imani Clinic http://cim.ucdavis.edu/clinics/imani/contact.htmU Kentucky http://www.mc.uky.edu/saclinic/student.htmBaylor HOMES Clinic http://www.homeless-healthcare.org/homesprogram/

contact.htmTufts Sharewood Clinic http://www.sharewood.info/board.phpYaleU of Rochester

UR Well

U of IL U-C HeRMES [email protected] http://hermes.navsaria.com/Vanderbilt Shade Tree [email protected] http://www.shadetreeclinic.orgMUSC CARES Clinic Megan Knight

[email protected] Elizabeth [email protected]

http://www.thecaresclinic.org

UIC SRFC Neal Sawlani [email protected] http://www2.uic.edu/stud_orgs/prof/clin/UTHSCSA Student run clinics Vannessa Sweet

[email protected]://studentrunclinics.org/index.cfm

Texas A&M Martha’s Health Clinic Lee Lee Nguyen [email protected]

http://medicine.tamhsc.edu/lrc/clinic/

UMMC Jackson Free Clinic [email protected] http://www.jacksonfreeclinic.org/Northwestern Devon Clinic Walid Alrayashi

[email protected]

Kansas U JayDoc Clinic http://volunteer.jaydocfreeclinic.org/index.phpChicago COM

Student Run Clinic [email protected] http://www.freewebs.com/ccomclinic/

U Penn United Community Clin. [email protected] http://www.med.upenn.edu/ucclinic/leadership.html


http://volunteer.jaydocfreeclinic.org/index.php




http://www.shadetreeclinic.org/


https://mail.urmc.rochester.edu/exchweb/bin/redir.asp?URL=http://www.sharewood.info/board.php

https://mail.urmc.rochester.edu/exchweb/bin/redir.asp?URL=http://www.homeless-healthcare.org/homesprogram/contact.htm

https://mail.urmc.rochester.edu/exchweb/bin/redir.asp?URL=http://www.homeless-healthcare.org/homesprogram/contact.htm

https://mail.urmc.rochester.edu/exchweb/bin/redir.asp?URL=http://www.mc.uky.edu/saclinic/student.htm

https://mail.urmc.rochester.edu/exchweb/bin/redir.asp?URL=http://cim.ucdavis.edu/clinics/imani/contact.htm

https://mail.urmc.rochester.edu/exchweb/bin/redir.asp?URL=http://www.med.nyu.edu/nycfreeclinic/contact/contact.html

http://pacific.stanford.edu/

https://mail.urmc.rochester.edu/exchweb/bin/redir.asp?URL=http://www.echo-clinic.org/index2.php?page=volunteers.php

https://mail.urmc.rochester.edu/exchweb/bin/redir.asp?URL=http://wccc.med.cornell.edu

https://mail.urmc.rochester.edu/exchweb/bin/redir.asp?URL=http://eastharlemhealth.org

http://meded.ucsd.edu/freeclinic/services.html


Appendix E: Key Informant Interview Responses

Tell me about your experience volunteering: Reasons for volunteeringHealth Team Senior Good opportunity to help community

To work in an underserved population Benefits for patients and students An opportunity for independent learning To practice clinical and interviewing skills

Health Team Junior To provide a needed service To work with an underserved population To have a more autonomy than work in preceptors office To have a different type of activity than what is provided in class

Referrals To provide healthcare to people without insuranceFront Desk To work with underserved populations

To prepare for future work with a free clinicMedical Assistant To gain clinical experience

To provide healthcare to uninsuredPhysicians To support the project

Provide opportunity for medical students to work with underserved populations and family physicians

Encourage students to have a sense of responsibility Enjoy working with medical students

Tell me about your experience volunteering: Opinions of structure of volunteer positionsHealth Team Senior Great: it mirrors hierarchy in medicine

Role of medical assistant could be taken over by health team to increase efficiency

Strength is allowing 4th year student to teach 2nd year Beautiful, perfect: allows patient contact for 1st years and more teaching for

2nd yearsHealth Team Junior Liked that 2nd year was able to contribute and 4th served as back up

Good to get 1st years involved in front endReferrals Good to have referrals come on a separate night because most places must be

contacted during business hoursFront Desk There is a disconnect between the number of interested first years and the

number of spots available Front desk is good for first years to gain exposure consistent with their level

of expertise Medical assistants lack continuity with only 3 sessions per year

Medical Assistant Medical Assistant position provides practice for 1st year Health team jr/sr combo allows for teaching of jr

Physician Allows students enough to have enough knowledge to formulate a plan Some pairs work better than others Don’t really see what goes on in the front end

What are benefits and drawbacks to working at UR Well: BenefitsHealth Team Senior Training to become a better doctor

Opportunity to serve the underserved Practice creativity in treatment plans due to financial restraints Work in a nourishing environment with appreciative patients Have a chance to teach fellow students

Health Team Junior Gain experience with a new set of medical issues Improve interviewing and physical exam skills Rewarding to work with appreciative patients

Referrals Learning to navigate the system in terms of finding referrals, setting up appointments

Front Desk Be able to see how a clinic is run Be able to meet patients and get exposed administrative side

Medical Assistant Be able to meet patients from varied backgrounds Gain experience with issues that a good proportion of city faces Rewarding to work with appreciative patients

What are benefits and drawbacks to working at UR Well: DrawbacksHealth Team Senior Inefficiency of the clinic

Inability to volunteer more frequently Unhealthy food in the back room Working under financial constraints

Health Team Junior Occasionally long days volunteering Inefficiency of the clinic

Referrals Not all interested people can be involved Coming in outside of the hours of clinic can be awkward

Front Desk Not always knowing what to do, this improves with timeMedical Assistant Downtime if patients no show

Not always clear about paperwork—would be good to have better orientation to patients’ paperwork.

In what ways did you learn from your time at UR Well?Health Team Senior Applying the biopsychosocial model to address needs of underserved

Applying concepts taught in class to patients Teaching health team juniors

Health Team Junior Applying physical exam and interviewing skills Learning importance of financial considerations Opportunity to teach patients about their disease, smoking cessation Observation of health team senior Getting feedback about performance from multiple people

Referrals Applying HIPAA concepts to work while calling patientsFront Desk Learned that uninsured doesn’t mean unemployed

Learned other barriers to healthcare eg time constraints due to multiple jobs, transportation

Applied smoking cessationMedical Assistant Improvement of skills learned in ICM

Increased awareness of new issues Learning importance of financial considerations Teaching patients about hypertension, physical activity, smoking cessation

How did the physician contribute to your education?Health Team Senior Teaching on topics pertinent to patient

Allowing health team senior to decide plan Observing how veteran clinician analyzes and synthesizes problems Working with physicians who are motivated to care for underserved

populationsHealth Team Junior Teaching on topics pertinent to patient

Observing physician with patient Willing to teach and motivated to be at clinic Having them observe skills and comment on presentations and notes

Referrals No interaction with physicianFront Desk No interaction with physicianMedical Assistant Not much interaction with physician

In what ways did you gain exposure to admin, financial, and human management aspects of medicine?Health Team Senior Learning about $4 prescription plan

Filling out billing codes on sheet Providing prescriptions and selecting based on balance of compliance and

cost

Providing labs and considering costs Added to knowledge of insurance disparities Meeting needs with limited resources Put faces to numbers of uninsured patients

Health Team Junior Filling out forms Determining when patients should return for follow up Logistics of ordering and drawing labs Arranging for referrals Putting faces to numbers of uninsured patients—working, homeless, lost jobs Learning about $4 prescription plan

Referrals Financial side as referral resources were scarce without insurance Issues with coordinating patients and providers

Front Desk Answering phones, scheduling patients, collecting fees Checking patients in and out Drawing labs

Medical Assistant Being a part of process of taking patient back and getting them ready for team Putting faces to numbers of uninsured patients—even children

What would you change about the clinic to benefit future volunteers?Health Team Senior More efficient scheduling: have online scheduling where you could pick days

you are available Have a database to track patients who return frequently to monitor the quality

of their care Nothing, the clinic runs well as it is Provide more longitudinal volunteer opportunities

Health Team Junior Would like more longitudinal volunteer opportunities but this must be balanced with getting people who are interested involved

Get a sheet when you arrive detailing your responsibilities Referrals Get more people involvedFront Desk Get anyone who is interested involvedMedical Assistant Allow medical assistant to go into room with patient to get more full exposure

of the patient experiencePhysician Have a list of specialist resources perhaps on a computer so that it could be

changed as resources change Send an email out to physician volunteers the week prior to their scheduled

night to confirm that they are working Have individual email addresses for all members of the steering committee

that would stay the same year to year even as the person changed. This would be especially helpful for the physician volunteer coordinator.

Consider adding another night, other specialties (you can rotate specialty), homeless outreach

What are the strengths and challenges of the clinic: StrengthsPhysician Organization

Pairing of health team junior and senior Students involved in all aspects of clinic Clinic is more efficient than it was when it first started and is seeing more

patients Advocacy for patients: follow up for issues and referrals is very good Students access available resources well

What are the strengths and challenges of the clinic: ChallengesPhysician Staying within allotted timesCan you tell me about the transition of the clinic from year to year?Physician Goes well in terms of recruiting

Would be good to have names and pictures of steering committee for physicians so key people are recognized

Some historical information is lost from year to year, but all major

information is passed on No barriers to the clinic remaining open in the future Clinic relies heavily on core volunteers who put in an incredible amount of

effort to maintain success of clinic, if leadership in this group were poor one year, the clinic might not survive

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