Clinic Brings Disciplines and Students Together for Patient Care

Late Saturday morning, Aug. 18, men, women and children were lined up inside a St. Vincent de Paul office in Cincinnati’s West End neighborhood. Inside, there was coffee, a food pantry and a charitable pharmacy—and, walking around the crowd, UC students handing out fresh strawberries and an invitation for a health screening.

The screenings are part of a unique partnership between St. Vincent de Paul and the University of Cincinnati. Overseen by faculty volunteers, students from the colleges of allied health sciences, medicine, nursing and pharmacy operate a free self-management clinic on the second floor of the building.

It’s a project of the UC chapter of Open School for Health Professions, an initiative of the nonprofit Institute for Healthcare Improvement. The Open School offers an online curriculum for professionals and students on a variety of topics in health care improvement, leadership and teamwork.

At the clinic, students work in pairs to measure patients’ height, weight, blood pressure and blood sugar, as well as interview them about their health and medical concerns. In the process, they gain experience working with other health care disciplines and studying continuous quality improvement processes.

"Essentially, the clinic began for two reasons,” says Jeff Alborn, a third-year PharmD student and information director for UC’s chapter. "It provides a much-needed service in that area of town and it gives us a practical platform to work together in a professional setting—to actually start practicing what we preach, basically.”

The chapter was started in May 2010 and is now run by student leaders from all of UC’s Academic Health Center colleges. The St. Vincent de Paul clinic functions as the chapter’s service learning site to practice skills learned in the course work—and each week, students focus on one or more aspects of the clinic to test and improve.

On Aug. 18, they focused on new patient interview forms. The forms were designed with group input and used during the clinic to record a patient’s history and lifestyle. But the chapter had to ensure that both caregivers and patients could interpret and answer all the form’s questions, and that they were easy to use for new student volunteers.

Chapter advisor and associate professor of medicine and pediatrics Tiffiny Diers, MD, says the clinic teaches students how to conduct and measure changes in live systems.

"We can’t anticipate how the medical field will change over time,” she says. "These students are learning quality improvement measures, care for vulnerable populations and health care improvement systems—those are powerful skills to have.”

In addition to screening for hypertension, diabetes and obesity, students from the College of Medicine and James L. Winkle College of Pharmacy College of Pharmacy administer vaccines and flu shots under faculty supervision. Once a month, nutrition students prepare recipes from the food pantry’s shelves and hold cooking demonstrations.

The chapter is also incorporating students from UC’s School of Social Work to help patients connect with local agencies and UC Blue Ash’s dental hygiene program to add dental health discussions to patient care.

At times, the clinic has sent patients directly to the emergency department. Students have recommended to patients to follow up with their primary care physician—or help them connect with a primary care physician if they don’t have one, the case for about one-third of their patients.

Because students don’t diagnose or treat clinic visitors, the patient interview is the central focus of their practice. Using the "Advancing Communication and Care by Engaging Patients” (ACCEPT) interview process developed by Cincinnati Children's Hospital Medical Center, students talk with patients about their health goals, their stage of readiness for change and what action steps they could take.

Diers says the interview method turns the historical doctor-patient relationship on its head: "We’re here to help facilitate the changes that patients want to make in their own life,” she says. "It’s not for us to choose their goals.”

Nutritional sciences student Kara Guisinger fell in love with the clinic’s work when she joined the Open School chapter. She said she learned to have confidence in her own knowledge while working to understand each client’s needs.

"There are some things that you don’t have to write a prescription for but that can be just as helpful and necessary,” she says. "Sometimes you have to sit there and listen. You may want to tell them everything you know, but you have to pace yourself, not overload anyone and not lecture. It’s really about listening, asking a lot of questions and letting patients guide your way through the process.”

During her first weeks at the clinic, second-year medical student and chapter co-leader and steering director Grace Miller remembers feeling "pretty awkward” talking to patients.

"I noticed that I would take on a different tone of voice during the clinic, like I was acting,” she says. "Medical students tend to do that.”

After time, Miller realized the patients weren’t as different from her as she once thought: "It’s important to be able to talk to someone like you talk to a friend.”

For Alborn, the shock of the clinic came in meeting patients drastically different from him—people experiencing drug abuse or homelessness, or who have diseases he’s only learned about in class.

Being able to talk with them and help them, he says, is a good feeling: "It takes away the textbook feel of practice and puts some real feeling into it. You have to be able to separate yourself from the coursework to learn.”

Chapter members also say the clinic teaches them how to work with different disciplines, a practice formerly reserved for after graduation. This fall, the Open School chapter will host educational sessions for students from each college to discuss different health care topics. But each week, they experience the teamwork directly in patient care.

"It’s a great experience,” says Miller. "I now know what the other students’ strengths are and, as a future physician, I know who to call on when I need help.”

For information on joining UC’s Open School chapter, visit ucopenschool.org.