National Student-run Free Clinic survey
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Smith S, Thomas R, Cruz M, Griggs R, Moscato B, Ferrara A. Presence and Characteristics of Student-Run Free Clinics in Medical Schools. JAMA. 2014;312(22):2407–2410. doi:10.1001/jama.2014.16066
Student-run free clinics (SRFCs) are common in medical schools,1-6 yet the current state of these clinics is not well described. The first national study of SRFCs conducted in 2005 described 111 SRFCs at 49 Association of American Medical Colleges (AAMC) member institutions.1 We conducted this survey to assess whether there has been growth of SRFCs in medical schools and describe the characteristics of these clinics.
We developed, pilot tested, and revised a survey instrument based on concepts addressed in the original survey,1 a literature review, and ongoing discussions with SRFC leaders from across the country. The final survey contained 39 items including yes/no, multiple-choice, and open-ended responses. The University of Central Florida institutional review board certified this study as exempt.
We identified SRFCs and their medical student leaders through the Society of Student-Run Free Clinics. When contact information could not be located for a SRFC at a US AAMC member institution, we telephoned or e-mailed student affairs offices to confirm the presence or absence of a SRFC, and to identify a free clinic student leader. We sent an e-mail to student leaders of SRFCs from each US AAMC member institution with a SRFC asking them to complete a web-based questionnaire between December 2011 and April 2014. One response was requested from each institution summarizing data from all SRFC sites at their school. Respondents were encouraged to seek input from other students or faculty, to record actual figures when possible, or best estimates. The survey appears in the Supplement.
We analyzed data using descriptive statistics (Excel version 14.2.5, Microsoft Inc). We calculated percentages based on the number of responses to each question for all yes/no or multiple-choice answers. Missing data were accounted for by decreasing the denominator of respondents accordingly. Two of the authors (S.S., R.T.) independently examined open-ended responses for recurrent themes, coded responses, and compared for agreement until consensus was reached.
We identified SRFCs at 106 of 141 (75.2%) US AAMC member institutions. The survey response rate was 81.1% (86/106). Two schools completed 1 joint survey because they work together at 1 SRFC. Therefore, the maximum number of responses to each survey item was 85 (range: 77-85 for multiple-choice questions except for budget-related items, which had 49-74 respondents; 60-67 for open-ended items).
The 86 responding institutions reported 208 SRFC sites. Table 1 provides details regarding clinic operations. More than half of medical students were reported to be involved in SRFCs (mean [SD], 57.8% [27.9%]), including first- through fourth-year students. Fifty-three percent (43/81) of institutions reportedly offered no academic credit for participation.
Table 2 summarizes the broad range of services provided by SRFCs, including chronic disease management, specialty care, imaging, laboratories, pharmaceuticals, and interdisciplinary services. The most common diseases treated in SRFCs were diabetes (58/77; 75.3%) and hypertension (58/77; 75.3%).
In open-ended responses, students identified the greatest strengths of SRFCs as serving the underserved (50/60; 83.3%) and student education (47/60; 78.3%). The biggest challenges were obtaining sufficient faculty staffing (26/60; 43.3%) and funding (19/60; 31.7%).
The number of AAMC member institutions with a SRFC has more than doubled since the last national survey was conducted 9 years ago1 and SRFCs are now present at more than 75% of medical schools. Despite the lack of academic credit at many institutions, most medical students are volunteering in this setting. Given the ubiquity of SRFCs in the education of future physicians, further research is needed to assess their educational and clinical outcomes. Small single-institution SRFC studies have documented high-quality patient care in diabetes, hypertension, and mental health.4-6
This survey did not include the many SRFCs hosted by osteopathic or interdisciplinary schools. Limitations of this study include the collection of data by self-report from a student leader, and a variable number of responses per item.
The lack of funding and sufficient faculty supervisors identified as the biggest challenges in SRFCs are actionable items because institutional support could help stabilize and improve these educational opportunities for years to come.
Corresponding Author: Sunny Smith, MD, Department of Family and Preventive Medicine, University of California, 9500 Gilman Dr, La Jolla, CA 92093 (firstname.lastname@example.org).
Author Contributions: Drs Smith and Thomas had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Smith, Thomas, Moscato, Ferrara.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Smith, Thomas, Cruz.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Smith, Thomas.
Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Previous Presentation: An earlier version of this study was presented at the Society of Student-Run Free Clinics Conference in conjunction with the Society of Teachers of Family Medicine; February 4, 2012; Long Beach, CA.
Additional Contributions: Ellen Beck, MD (University of California, San Diego), initiated the first national conference on student-run free clinics as a 2008 Society of Teachers of Family Medicine preconference workshop and has been a lead faculty advisor to the Society of Student-Run Free Clinics, through which this collaboration and survey project was made possible. No compensation was provided to Dr Beck for her work on this project. We thank the members and leadership of the Society of Student-Run Free Clinics as well as the student leaders, faculty, volunteers, and patients from across the country.
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