Browsing by Author "Kabir, Jason"

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    Balancing Access to Care and Volunteer Well-Being Through a Student-Run Free Clinic Phone Line Operating Model
    (2022-03-27) Kabir, Jason; Bednarski, Olivia
    Introduction/Problem: Many student-run free clinics (SRFCs) take on the role of primary care for their underinsured patient population, which necessitates patients having access to communication with the clinic. However, this can be difficult for SRFCs due to limited operating hours and competing educational and personal responsibilities of students running the clinic. Several volunteers at our SRFC elect to use their personal phone numbers to communicate with patients throughout the week, but it is important for the clinic to have an official phone number to serve as a centralized contact point for the community members it serves. We will describe various methods of phone communication with our patients and focus on our newly-implemented model for operating a clinic phone line. Methods/Interventions: We maintain a prepaid clinic cellular phone funded by student fundraising efforts. Each week one medical executive board member is in possession of the phone and is responsible for responding to calls. A second board member who is a 4th year medical student (MS4) serves as a back-up call for the first board member to contact should they have questions about how to handle a patient’s inquiry. Board members are expected to keep a log of each phone call, voicemail, or text message and the action they took on a shared HIPAA-secure Google Drive. These logs were reviewed to evaluate this model. Results: Each board member was “on call” for a median number of 2 weeks and each MS4 board member was back-up call for a median of 5 weeks in 2021. Phone logs were kept for 15 weeks from January to November 2021. A total of 87 interactions with patients were documented, including 21 appointment questions, 12 general questions, 8 inquiries about medication refills, and 8 questions following up on their most recent clinic visit. The average monthly cost of keeping the phone line active from January to November 2021 was $28. Conclusion: Maintaining a clinic phone can be a cost-effective method to ensure patients at an SRFC have access to their providers while also protecting volunteers’ privacy and personal time. Dividing responsibilities for making necessary outgoing calls and taking incoming patient calls among clinic leadership reduces the burden on individual leaders. SRFCs are an important part of students’ training, and this model can be implemented at SRFCs to promote a culture of establishing professional boundaries.
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    Fostering Leadership in a Student-Run Free Clinic Medical Executive Board and Across Interdisciplinary Partners.
    (2022-03-30) Haddad, Aida; Khan, Maria; Gensel, Annie; Barber, Mckenzie; Aksu, Eric; Klipsch, Eric; Class, Jon; Brown, Lucy; Kabir, Jason; Etling, Mary Ann
    Background: Being a member of a healthcare executive board requires a unique sense of resolve and passion for service. Not only are these leaders operating a student-run free clinic, but they are also full-time professional students while balancing extracurricular activities to discern their healthcare vocation. Board members feel pulled in many directions, resulting in imposter syndrome and possibly untapped leadership potential. Leadership succumbing to this pressure in 2021 might have resulted in the permanent closure or dysfunction of a clinic after COVID-19 required closure for one year. This study will discuss the interventions employed by the clinic’s Chair, Vice-Chair, Women’s Health co-chairs, and Operations chair to overcome the burden felt when faced with reopening a large, interdisciplinary, free clinic serving approximately 34 patients per weekly clinic day. Though fostering interpersonal relationships best encompasses the theme with which the above leaders encouraged hope during a time of global suffering, relationships were encouraged through multiple discrete interventions forming camaraderie and trust within and between interdisciplinary executive boards. Interventions: Medical Executive Board: In anticipation of the added pressures of reopening the clinic amid COVID-19, the Chair took special care to create a culture of collegiality and mutual vulnerability by facilitating various ways to ‘check-in’ with her board. She hosted preterm and midterm check-ins with each leader to discuss their vision for their role on the board. The Chair and Chair-elect also hosted the clinic’s first annual leadership retreat to support each member in finding their leadership style, and in turn, becoming familiar with their colleagues’ leadership styles. The Chair and Chair-elect will also perform exit interviews with all graduating board members. Partners: Reopening during the pandemic meant reorganizing the entire clinic flow and limiting the number of volunteers present. As a result, many interdisciplinary partners could not participate in the initial reopening and had to be brought in slowly throughout the year. Partner participation was encouraged by monthly meetings with all partners (regardless of clinical presence), and an active group chat with leaders. The Vice-Chair also emphasized alternate means of participation. Some partners organized winter clothes and food drives, while others fundraised for the clinic. All partners were encouraged to develop telehealth plans. The fall partners’ retreat fostered community, during which all partners brainstormed 2022 goals. Results/Conclusion: Medical Executive Board: As a result of the above interventions, clinic leadership not only reopened the free clinic but fulfilled many years-long goals, which include rolling out a weekday telehealth protocol, serving record numbers of patients during a time of immense need, publishing the inaugural clinic-wide monthly newsletter, and formulating the clinic’s first-ever mistreatment policy. The leadership retreat inspired our Women’s Health Coalition to host a retreat; a check-in with the Women’s Health chair led to a midterm co-chair election to sustain the coalition long-term. Finally, the Operations chair spearheaded changes to clinic flow to avoid COVID-19 outbreaks–in doing so, she inspired a record turnout for this position at the 2022 elections. Partners: By the end of 2021, all interdisciplinary partners had resumed in-person care. However, the regular monthly meetings, alternate projects, and retreats fostered community and interest in the clinics even when all could not physically participate.
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    Pipelines to Leadership: Strategies for Executive Board Recruitment at a Student-Run Free Clinic
    (2022-03-30) Kabir, Jason; Salgado, Christina; Class, Jon; Brown, Lucy
    Introduction/Problem: The Covid-19 pandemic placed restrictions on student-run free clinics (SRFCs) across the nation. Guidelines set forth by our medical school’s administration restricted in-person participation at our SRFC from April 2020 to March 2021 for clinical students and April 2020 to September 2021 for pre-clinical students. With medical executive board elections occurring annually in October, it was uncertain whether eligible pre-clinical students would feel confident enough in their experience to run for and fulfill the responsibilities of a board position. In this paper, we will present leadership opportunities and strategies to recruit candidates for an executive board at an SRFC. Methods/Interventions: Additional volunteer positions, including a new Assistant Clinic Manager position, were added for pre-clinical students prior to the election. Members of the clinic’s established teams, such as the Continuity of Care Team, were encouraged to run in the election. An additional board position was transitioned to a two-year position. The current board members participated in a question and answer session about their positions and informally mentored interested candidates outside of this session. Candidates’ written platforms and volunteer sign-up records were analyzed to determine the impact of these interventions. Results: Twenty-seven candidates ran for 14 board positions up for election. Fifty-six percent of the candidates were pre-clinical students, of which 47% had the opportunity to serve in the Assistant Clinic Manager position. Eighty-five percent of candidates were members of one of the clinic’s teams, and 100% of the candidates elected had previously served on a team or as a board member, which are higher percentages than in previous years. Conclusion: Despite pre-clinical students eligible to run for a board position given the opportunity of only 7 clinic days over 2 months (with a limit of one general volunteer shift per month) to serve in-person, the election attracted a similar number of candidates as previous years. In addition, candidates’ motivation to improve upon things they had been involved with at the clinic, often beyond their responsibilities on clinic day, played a large role in the 2021 election. While a variety of methods can be used to motivate volunteers to pursue executive board positions, our work shows SRFCs can offer leadership positions outside of the executive board, possibly through clinic teams, to serve as a pipeline for volunteers to pursue increasing clinic ownership and responsibilities.
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    We Do it For Our Neighbors: Ethics in Action at a Student-Run Free Clinic
    (2022-03-31) Kabir, Jason
    The Covid-19 pandemic presents a disruption in the services offered by healthcare facilities across the nation, including student-run free clinics (SRFCs).  SRFCs may face extended disruptions during the pandemic due to the sponsoring schools’ policies to protect students and patients.  However, restricting students from participation in SRFCs comes at the cost of acute and chronic disease management of patients, many of whom are marginalized populations whose only source of healthcare is free clinics.  In this paper, we will argue how the management of a SRFC and the trust it has built in its community can demonstrate the emphasis on patient care over volunteer or learning experiences for students. There is literature proposing a virtues-based ethical framework with patients’ needs as the first consideration in management of SRFCs(1).  We will demonstrate what these principles in the ethics literature look like in practice at a SRFC.  We will explain mechanisms by which leaders of a student-run free clinic can take ownership of the care of their patient population, such as by following up appropriately on screening and diagnostic tests offered and having appropriate avenues for referral if results are abnormal.  We will present ethical considerations that arise with this ownership and balancing a student-led learning environment with equitable patient care, as well as opportunities for improvement.  Implementation of these practices can be used to argue the importance of SRFCs for communities in the face of disruptions related to the Covid-19 pandemic and beyond.  1. Coverdale JH, McCullough LB. Responsibly managing students’ learning experiences in student-run clinics: A virtues-based ethical framework. Teaching and Learning in Medicine [Internet]. 2014 Jul 10 [cited 2021Nov 24];26(3):312-15. Available from: https://doi.org/10.1080/10401334.2014.910460
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    Why Did You Draw My Blood?: A Model for Lab Follow-Up Allowing Dynamic Treatment Plans at a Student-Run Free Clinic
    (2022-03-26) Kabir, Jason
    Introduction/Problem: Prompt review and communication of lab results to patients is critical for forming appropriate treatment plans, but it can be a difficult task for student-run free clinics (SRFCs) due to a number of limiting factors, including week-to-week turnover of clinic volunteers and staff. The previous model employed by our SRFC placed the responsibility on one clinic manager the morning of the following clinic day, one week later. This placed a necessary but disproportionate stress on this clinic manager who was less familiar with the previous week’s patient encounters and could not make dynamic changes in patients’ treatment plans due to time constraints. We will present the details of a new model employed by our SRFC for lab follow-up. Methods/Interventions: The responsibilities of entering lab results into the electronic medical record (EMR) and calling patients with their results is divided among five clinic managers to be completed each week following Saturday clinic. Completion of lab follow-up is documented in a shared HIPAA-secure Google Sheet. This hand-off sheet was reviewed with cross-reference to the EMR to evaluate the new model. Results: From March to November 2021, a total of 324 phone conversations and an additional 170 attempts to communicate lab results with patients were documented. Twenty-four of those conversations resulted in a follow-up appointment being made sooner than planned during the previous encounter; 41 conversations included counseling on lifestyle modifications; and 53 conversations included additional counseling on the results, return/emergency department precautions, or connection to a higher level of care. Seventy-three percent of the conversations communicating abnormal results had actions like these beyond communication of the results documented. Conclusion: Dividing lab follow-up responsibilities among clinic leadership following each clinic day allows patients to be more in control of their health and avoids delays in care. This model also relieves pressure and saves time for volunteers the next clinic day by allowing them to focus on the encounters occurring that day. Developing a systematic approach for communication of lab results was an advancement for our SRFC, and this model can be applied at SRFCs across the nation.