Rutgers student-doctors lead an interdisciplinary team of health students in providing care for underserved New Brunswick residents
NEW BRUNSWICK NJ – SOLUTIONS – Stephanie Oh knows what it’s like to live at the poverty line. After graduating college with a degree in bioengineering, she volunteered for AmeriCorps and subsisted on food stamps. “This experience made me better understand the struggles people face trying to live healthy on a limited income,” says Oh, now a medical and doctoral student in neuroscience at Rutgers Robert Wood Johnson Medical School in New Brunswick, NJ.
Today, Oh puts her knowledge of medicine and indigent and homeless populations into practice as the student director of the Promise Clinic, an initiative that provides primary health care for clients of Elijah’s Promise Community Kitchen in New Brunswick.
The Promise Clinic, founded in 2005, is one project under the medical school’s Homeless and Indigent Population Health Outreach Project (HIPHOP), which fosters relationships between medical students and the local community by providing free care to this population.
HIPHOP also supports the Community Health Initiative (CHI), in which medical students present health workshops at community sites, shadow a physician who provides services to the indigent population at the Robert Wood Johnson AIDS Program and Rutgers Eric B. Chandler Health Center, and participate in community outreach throughout New Brunswick. Up to 600 students volunteer annually in both programs.
“When health care students become knowledgeable about the people they serve, they are better able to practice patient-centered medicine,” says Susan Giordano, HIPHOP program coordinator. “Our goal is for student leaders to promote and advocate for the community by instilling humanism in medicine.”
As of the 2010 census, approximately 34 percent of New Brunswick residents live in poverty. Each summer, Giordano runs an internship for HIPHOP’s incoming student leaders that introduces them to partner organizations and takes them on a community tour to teach about the logistical challenges residents – without a car and on tight budgets – face in eating healthy, accessing medical care and obtaining support.
“The tour is eye-opening,” says Gloria Chen, CHI student director and second-year medical student. “It makes us aware of how difficult it is for our patients to have healthy lifestyles. There are a lot of services they can’t access since they don’t have transportation.”
As the clinical arm of HIPHOP, the student-run Promise Clinic provides free primary care services at Rutgers Eric B. Chandler Health Center to the uninsured adult clients of Elijah’s Promise community soup kitchen. Over the past two years, the students have raised more than $30,000 to help cover medical expenses.
Since its start in 2005, the Promise Clinic’s network has expanded to include students from Rutgers School of Public Health, School of Health Professions’ physicians assistant program, School of Social Work, School of Pharmacy and resident-physicians from the Rutgers program in General Psychiatry, who work collaboratively with the medical students. The Promise Clinic also benefits greatly from the efforts of volunteer attending physicians from Robert Wood Johnson University Hospital departments of family medicine, internal medicine and emergency medicine, who precept the student-doctor teams and provide clinical mentorship.
“The partnerships allow us to learn how to work as an interdisciplinary team,” says Oh, who has served at the clinic since 2011. “Health is not just a state of physical wellness – it’s also mental and social wellness. Our student-doctors are learning that in order to ensure a patient’s wellbeing you have to be able to take care of all these facets together.”
Each year, approximately 45 teams of four to five medical students see patients under the supervision of faculty advisers. The teams – composed of first- through fourth-year medical students – care for the same one to two individuals throughout their medical school experience. In addition, patients also see students from the interdisciplinary practices as their care warrants. Since its inception, the Promise Clinic has seen about 600 patients, who visit once every few months.
Students join the team in their first year; when they enter their clinical rotations, their role changes to teaching the first- and second-year students in their team. “By providing a continuum of care to the same patient over four years, students gain a strong knowledge of the patient’s condition and form a bond,” Oh says. “It’s a rare opportunity for students to care for a specific patient in a very personal way. I have seen student doctors spend hours arguing with pharmacological companies to lower the cost of medicine or advocate for patients with charity care.”
Health literacy and language are barriers in this population – over 50 percent of New Brunswick residents are non-English speakers. To meet this challenge, bilingual medical students are trained as medical interpreters and medical and social work students serve as health navigators.
As a result of their experience, many students remain in primary or family care, Oh says.
“I once thought that change happened on a large scale – though policies,” she notes. “But I see now that it’s all about the individual relationships between doctors and their patients.”