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Medical Students as Health Educators at a Student-Run Free Clinic: Improving the Clinical Outcomes of Diabetic Patients

Gorrindo, Phillip PhD; Peltz, Alon MD, MBA; Ladner, Travis R.; Reddy, India; Miller, Bonnie M. MD; Miller, Robert F. MD; Fowler, Michael J. MD

doi: 10.1097/ACM.0000000000000164
Research Reports

Purpose: Student-run free clinics (SRFCs) provide service–learning opportunities for medical students and care to underserved patients. Few published studies, however, support that they provide high-quality care. In this study, the authors examined the clinical impact of a medical student health educator program for diabetic patients at an SRFC.

Method: In 2012, the authors retrospectively reviewed the electronic medical records of diabetic patients who established care at Shade Tree Clinic in Nashville, Tennessee, between 2008 and 2011. They compared clinical outcomes at initial presentation to the clinic and 12 months later. They analyzed the relationship between the number of patient–student interactions (touchpoints) and change in hemoglobin A1c values between these two time points and compared the quality of care provided to best-practice benchmarks (process and outcomes measures).

Results: The authors studied data from 45 patients. Mean hemoglobin A1c values improved significantly from 9.6 to 7.9, after a mean of 12.5 ± 1.5 months (P < .0001). A trend emerged between increased number of touchpoints and improvement in A1c values (r2 = 0.06, P = .10). A high percentage of patients were screened during clinic visits, whereas a low to moderate percentage met benchmarks for A1c, LDL, and blood pressure levels.

Conclusions: These findings demonstrate that a medical student health educator program at an SRFC can provide high-quality diabetes care and facilitate clinical improvement one year after enrollment, despite inherent difficulties in caring for underserved patients. Future studies should examine the educational and clinical value of care provided at SRFCs.

Dr. Gorrindo is a trainee, Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee.

Dr. Peltz is a resident physician, Department of Medicine, Boston Children’s Hospital, and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.

Mr. Ladner is a medical student, Vanderbilt University School of Medicine, Nashville, Tennessee.

Ms. Reddy is a trainee, Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee.

Dr. Bonnie Miller is senior associate dean for health sciences education, Vanderbilt University School of Medicine, Nashville, Tennessee.

Dr. Robert Miller is associate professor, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.

Dr. Fowler is assistant professor, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.

Funding/Support: This project was supported in part by award T32GM07347 from the National Institute of General Medical Sciences/National Institutes of Health for the Vanderbilt Medical Scientist Training Program (P.G., I.R.) and award UL1TR000445 from the National Center for Advancing Translational Science/National Institutes of Health for the Vanderbilt Institute for Clinical and Translational Research. Funding from the Association of American Medical Colleges Caring for the Community grant, the Boulevard Bolt Foundation, and the Nashville Baptist Healing Trust provided program and patient care support.

Other disclosures: None reported.

Ethical approval: The Vanderbilt University institutional review board approved the study’s protocol as an exempt research project.

Disclaimers: This article reflects the views of the authors and does not reflect the opinions or views of any of the above listed funding sources.

The authors have informed the journal that they agree that both Dr. Gorrindo and Dr. Peltz completed the intellectual and other work typical of the first author.

Correspondence should be addressed to Dr. Gorrindo, Medical Scientist Training Program, 340 Light Hall, Vanderbilt University School of Medicine, Nashville, TN 37232; telephone: (615) 322-3408; e-mail: phillip.gorrindo@vanderbilt.edu.

© 2014 by the Association of American Medical Colleges