TRAINING GROUNDS

Student-led clinics offer experience to learners, care to the underserved

Walk into the Pitt County Care Clinic on any given Sunday afternoon and you will see a group of enthusiastic yet nervous medical students huddled together, chatting to ease their nerves. Each of them is ready to experience their first dose of patient interaction.

Dressed professionally and ready to act the part of doctor, anyone can sense their desire to help people who have nowhere else to turn for their medical care. Meanwhile, the experience is preparing them to practice the clinical skills necessary for their careers.

This has been a weekly scene for more than 25 years as students at East Carolina University’s Brody School of Medicine have dedicated their time and volunteered their ever-growing knowledge at two student-run clinics to help the underserved and uninsured populations in Pitt County: the Greenville Community Shelter Clinic and the Pitt County Care Clinic.

Filling a gap

The Greenville Community Shelter Clinic, founded in 1989, was the first student-run clinic opened in Pitt County. Located at the Crossroads Community Center, the clinic focuses on offering medical care to the homeless. Under the supervision of volunteer faculty, first- and second-year students assist an attending physician by obtaining each patient’s medical history, taking their vital signs and learning their chief medical complaint.

Students gain real world experience in treating patients because the attending physicians allow them to participate in the diagnosis process as well as the development of a treatment plan for each patient.

“We are constantly reminded by the (shelter) residents that we are their only source of medical care, aside from trips to the emergency department. This means that the residents rely on us for their check ups, medications and acute care needs,” said Zachary Williams, second-year medical student and student co-director at the shelter. “These patients are not fortunate enough to have the means for adequate health care outside of the free services we provide weekly.”

Brody School of Medicine first-year student Jasmine Bryant speaks with supervising physician Dr. Robert Shaw at a student-run clinic at the Pitt County Health Department.

With the help of volunteer medical students, pharmacy residents, physician assistant students, dental students and pre-health undergraduate students, the clinic sees an average of eight to 12 patients during every three-hour session. Most people come to the shelter clinic with common health issues such as hypertension and diabetes, but their ailments have progressed because they lack access to regular care.

“The medical clinic is an outstanding resource not only for the residents of the center, but for the citizens of West Greenville as well,” said Bob Williams, executive director of Crossroads Community Center. “The School of Medicine is to be commended on their compassion and willingness to give back to the community.”

Over the years, the students have expanded the services of the clinic by adding a Women’s and Pediatric Clinic. In addition to free medical care, the clinic provides patients who live at the shelter access to an onsite pharmacy stocked with medicine donated by local pharmacies. Shelter residents who visit the clinic also receive one free visit annually at the ECU Family Medicine Center.

The Shelter Clinic is open to the public every Monday from 6:30-9:30 p.m. for general care and every other Thursday for women and pediatric patients.

Building cultural competency

A second student-operated clinic – the Pitt County Care Clinic – opened in 1998. Formerly known as the Grimesland Clinic, the site has served more than 2,300 individual patients, with 80 percent of them of Hispanic ethnicity.

In this weekly operation, which relocated to the Pitt County Health Department in July 2015, first and second-year medical students experience clinical situations in which patients speak another language and may have different cultural practices.

Brandon Winfrey, a second-year medical student and student co-director of the clinic, appreciates the ability to work with a culturally different population. “My Spanish isn’t perfect, but the people that we help don’t care; they are really thankful for what we are trying to do.”

“It is a learning environment for working with a different culture,” said Dr. Harry Adams, director of clinical education in the M1 and M2 years at Brody and volunteer physician at the Pitt County Care Clinic. “That’s the way the U.S. is becoming. You are going to be working with patients from a different culture more and more, and this is a good training ground for that.”

Like those serving at the shelter, students serving at the Pitt clinic assist attending physicians by obtaining medical histories, taking vital signs and learning the complaints of each patient. Then students observe how the attending physician physically assesses the patient and determines a course of treatment.

“The first time I volunteered, my heart was beating so fast and I was so nervous,” said Talia Horwitz, a second-year medical student and student co-director of the Pitt County Care Clinic. “I didn’t even know how to take vitals then. But the second time I was able to come back and be so much more physically comfortable. That allowed me to understand how much of an invaluable experience this was.”

The most common health concerns patients present here are diabetes, high blood pressure, and viral and bacterial infections. Most medications are provided to patients free of charge – or at minimal cost – through an onsite pharmacy.

“We learn all of these things in school; we learn diseases and pathways and all of this stuff, and they try and teach us how to talk to patients, but you can’t learn that from a book. You have to actually be in the clinic. That is what this clinic gives you,” Horwitz said.

The Pitt clinic also benefits from the volunteer participation of physician assistant students, pre-health undergraduates and nurses, so students get a taste of delivering health care as part of an interprofessional team. They collaborate annually with students from the ECU School of Dental Medicine to hold a dental clinic that provides free dental care.

The Pitt County Care clinic is open to patients of all ages and genders every Sunday from noon to 4 p.m.

Learning to serve

Both clinics allow first and second-year medical students to get out of the classroom and see what is to come over the next several years in their education, and eventually in their careers.

“Our life is consumed with studying and school, but it is really nice to have an outlet that is not that,” said Horwitz. “Not only is this helping the community, but it is good clinical, teamwork and leadership experience.”

“I have seen students in the first year that don’t even know which end of the stethoscope to use, and by the end of the second year they are really comfortable working here in the clinic,” said Dr. Adams. “It’s a great maturing, learning experience for the students.”

While gaining clinical experience is helpful for these future health care providers, the clinics provide much more than a blueprint of how to treat a patient. They also remind students that they have a responsibility to use their education to make a difference in the lives of people who need it the most.

“Seeing health care disparities firsthand and working with a population desperately in need of better health care will keep me grounded in my practice and remind me of the needs of the underserved,” said Zachary Williams. “Volunteering with the underserved has further fueled my desire to volunteer in remote areas domestically and abroad once I am a practicing physician.”