ANNUAL FEATURE: IN PROGRESS: REPORTS OF NEW APPROACHES IN MEDICAL EDUCATION: CURRICULUM: Hot Topics
Section Editor(s): ANDERSON, M. BROWNELL
Association of American Medical Colleges
UNIVERSITY OF CALIFORNIA, BERKELEY
Inquiries: Alan Steinbach, MD, UCB-UCSF Joint Medical Program, Division of Health and Medical Sciences, 570 University Hall, Berkeley, CA 94720-1190.
Objective: Ten years ago, medical and public health students at the University of California, Berkeley were inspired to provide direct services to the homeless population. The name Suitcase Clinic (SC) was adopted to symbolize the format of going wherever the clients could be found.
Description: The SC is based on service and student-centered learning and is coordinated on an all-volunteer basis by UC Berkeley undergraduate, medical, and optometry students. Medical, chiropractic, vision screening, legal, and dental services are among those provided. This model of an interdisciplinary team approach administered overall by students provides the unique foundation of the clinic.
The Suitcase Clinic has three divisions: General Clinic, Women's Clinic, and a new Youth Clinic. Each offers a drop-in clinic providing holistic care one night a week at local churches. Client services are coordinated by a council of undergraduate student coordinators who have worked in the clinic and are elected to their positions. Clients meet individually with an undergraduate student caseworker (SCW) who follows the client throughout the visit. During medical services, the SCW and medical student first interview the client, then present the client to the attending physician, who examines the client and facilitates final treatment decisions. The SCW arranges follow-up visits and referrals to outside resources as needed.
A UCB undergraduate class provides training and produces the students who run the organization. The class is also entirely organized and run by student volunteers. Co-coordinators and a staff of six to eight undergraduate instructors are elected from volunteers who have already completed the class. Physicians provide advice and often lecture on topics pertinent to the clinic's work. Until last year, the class used a conventional lecture- and section-based format, but the students began a reorganization to improve training of student caseworkers. The first six sessions of class now have less lecture and more small-group process. Each session deals with a service issue, such as suicidal ideation, and emphasizes discussion of attitudes towards service and skills in communication rather than academic knowledge of homeless issues. A mock interview forms the final test of this basic training.
The graduate-level course is open to master's-degree and medical students, with much of the content woven into teaching during client conferences in the clinic. Medical students volunteering in the clinic have an opportunity to practice team care in a less pressured setting then they will experience in more formal medical curricula.
Discussion: Students working together to run the Suitcase Clinic experience the problems inherent in working in teams. They learn to identify solutions in a setting, though, where they are in control and under less pressure to perform. The operating hypothesis is that early team experiences will make for more effective professionals as they enter their careers. Exactly which parts of the experience have the effect remain to be elucidated by studies now being planned. This unique and positive learning experience suggests that medical schools located near undergraduate institutions might do well to consider establishing such clinics to promote early awareness of effective teamwork.
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