UC San Diego Student-Run Free Clinic Project
Medical students dedicated
to providing medical care to the uninsured and under-insured population
take an elective course to learn how to do it well at three student-run
free clinics in San Diego. Under the supervision of UCSD faculty physicians
and more than 45 volunteer physicians from the community, students learn
all aspects of free clinic management and administration in addition to
conducting clinical procedures. Ultimately, they develop leadership skills,
become sensitive to the special needs of the underserved, and learn how
to partner with community-based organizations.
are critical to ensuring the patient's access to health care, and the UC San Diego
Free Clinics are proud to be working side by side with the UCSD/UCSF Clinical
Pharmacy Program, California Professional Lab Owners, the Pacific College
of Oriental Medicine, Harvest for the Hungry, Baker Elementary School (the
only public Montessori school in the country), University of San Diego
Legal Clinic, the Third and Ash Charitable Organization (TACO), VA Social
Workers, the Council of Community Clinics Purchasing Collective, and pharmaceutical
company Patient Assistance Programs.
Since its inception in 1997, the Program
has conducted over 2,500 patient visits and provided, in addition, dental
clinics, disease prevention education, and early detection screenings to
many more in the underserved community. The Free Clinics nurture the students'
compassion and desire to serve; they learn that they CAN make a difference.
Serving as a model for a similar program at UC-Irvine, the program is so
successful that Baylor University's School of Medicine and The University
of Texas School of Medicine have invited program director Ellen
and one of her community partners to address their medical students in
preparation for setting up a joint student-run Free Clinic in their communities.
Faculty Development Program - Addressing the Health Needs of the Underserved
More than 20 family medicine physicians from across the country attended
the innovative Faculty Development Program "Addressing
the Health Needs of the Underserved" last year. Under the direction of Dr. Ellen
Beck, the program provides the physician with the administrative, scholarly,
and teaching skills to develop and implement programs in the primary care
of the underserved.
The 3-week course curriculum features lecture, self-directed
study, and independent research in the following areas: Community Health
(Environmental/Occupational, Promotoras model, inner city schools, student-run
free clinics), Teaching Skills (presentation skills, course design, program
evaluation, use of simulated patients), Research Skills (needs assessment,
finding data, collecting data, using data to change policy), and Administration
Skills (leadership development, small group facilitation, rotation implementation,
Designed to aid the practicing or teaching family
medicine physician to develop teaching programs for medical students or
residents in community medicine, do research in primary care of the underserved,
and create community-based programs, this Faculty Development Program has
also motivated its students to take on high-visibility leadership roles.
As founders of the national Physician and Teachers Advocating for the Underserved,
one of their members will sit on the board of the Association of Clinicians
for the Underserved. Alumni of the Program will also attend and call informal
meetings at national conferences sponsored by such organizations as the
Society of Teachers of Family Medicine and the American College of Physicians.
Por La Vida
Under the direction of Professor
Ana Navarro, Por La Vida
uniquely combines service to the community with high quality research in
public health. For more than ten years, in collaboration with San Diego
State University's Public Health programs, Por La Vida has involved the
Latino community in public health education and screening programs, with
an emphasis on cancer prevention. Currently, its Cuidandome program studies
whether a significant increase in intake of fruits and vegetables affects
the incidence of cancer in the population. Consejeras (lay teachers from
the community) use culturally relevant approaches to teach women how to
continue eating and serving their families favorite foods using recipes
that incorporate fruits and vegetables to better balance the intake of
The women who participate, at the urging of the consejeras, invite "learning
partners" (friends, acquaintances, and family members) to attend the
educational sessions with them and participate in an interview after the
program sessions end. Since 1997, 36 consejeras taught 450 participants
who introduced 900 learning partners to the Program. About 88% of the participants
and learning partners returned to participate in the interview, which indicates
that the research aspect of this Program is almost as highly valued as
the educational sessions themselves.
Por La Vida's Breast Cancer Early
Detection Program, conducted from 1995 to 1996, was equally successful.
Twenty-two consejeras taught 275 women the importance of mammography, clinical
breast exam, and breast self exam (demonstrated as part of the Program)
in the early detection of breast cancer. Nine hundred learning partners
participated as well. Similar programs have been conducted by Por La Vida
in the areas of cardiovascular risk reduction; alcohol, tobacco, and other
drug abuse prevention; and tobacco control. Over the past decade as many
as 130 consejeras have been trained, and they, in turn, have educated between
4,000 and 5,000 members of the community.
The key to Por La Vida's success
is creating trust in the community-by validating and utilizing cultural
values to affirm healthy lifestyles and personal empowerment and by returning
over and over again to the community to report on research findings that
will clearly benefit the long-term health of its population.
de Paul Village and UCSD's Family Medicine-Psychiatry Residency Training
A strong alliance with the world-renowned St. Vincent de Paul Village
allows the UC San Diego Combined Family Medicine-Psychiatry Residency Program,
under the direction of Dr.
Margaret McCahill, to offer a unique, first-ever
combined Family Medicine-Psychiatry Residency Program that has its out-patient "medical
home" in a free clinic that serves the homeless community.
de Paul Village Health Services is a licensed community clinic located
in a primary care medical health professional shortage area (HPSA), also
making it a medical underserved area (MUA). Since it has been estimated
that approximately 75% of the homeless (at least one-third of whom are
women and children) have mental illness or substance abuse, or both, these
otherwise medically-underserved individuals have unique needs which might
be best served by a Family Physician-Psychiatrist. More than 50 applications
have been received for the two combined residency positions available annually.
The five-year residency program is enjoying growing interest among medical
students seeking a career with this unique, dual specialty practice, in
service to the homeless and medically underserved. Comprehensive services
and continuity of care are the hallmarks of the Village. Offered at the
Village are literacy and adult education (including completion of GED;
chemical dependency treatment; the "Challenge to Change" program
which addresses specific causes of homelessness for the person; job preparation
and training for specific careers provided onsite by the local community
college; school from kindergarten through grade 12 provided on-site by
the San Diego City Schools), and day care service provided for mothers
The Village, because of its comprehensive continuum
of services, has an outstanding record of ending homelessness for those
individuals who complete the program. The St. Vincent de Paul Village Medical
Clinic serves those persons residing in the Village as the first priority,
the homeless on the street as the next priority, and the local poor-but-housed
(uninsured) as the next priority. Because all care, laboratory, and medications
provided at the clinic are free of charge to patients, there is a long
line of people seeking care each day. The Clinic provided 6,000 visits
in 1992; when UCSD School of Medicine trainees started regular rotations
at the clinic it increased to 15,727 visits in 1995-96, and this increased
further to 26,000 visits in calendar year 1998. UCSD's residents provide
the highest quality of primary care available in San Diego to this special
population, and provides their psychiatric care as well.
Residency: Addressing the Needs of the Underserved in San Diego's Latino
Under the direction of Dr.
Marianne McKennett, this residency
program increases opportunities for family medicine training in the Latino
community, improves the ability of all primary care providers to meet the
needs of Latino patients, involves academic and community family physicians
in research directed at Latino health care needs, and increases the number
of Latino academic family physicians and involves them in all three facets
of academic family medicine: teaching, research, and patient care.
service area of SYHC (the southern coastal region of San Diego County extending
from National City south to the Mexican Border) has been deemed a primary
medical care health professional shortage area (HPSA), also making it a
medically underserved area (MUA). Accredited in 1998, the UC San Diego-affiliated
Scripps Memorial Hospital, Chula Vista, Family Practice residency program
fills many of the service gaps that exist in this community, increasing
access to care for this population. Residents take part in and expand the
community outreach of the SYHC in the areas of AIDS prevention, outreach
to injection drug users, TB control, cancer screening, and perinatal care.
The majority of inpatient training occurs at Scripps memorial Hospital-Chula
Vista. Since most of the SYHC patients are hospitalized there, this allows
for continuity of care from outpatient to inpatient. The affiliation also
allows UC San Diego to fulfill a part of their commitment to training more generalist
Dr. Ted Ganiats has studied and reported on
quality of life issues related to diabetes, HIV, carotid atherosclerosis,
and stroke prevention. He has lectured on assessing cost analysis and cost/effectiveness
and on outcomes assessment in research and primary care at numerous national
and international conferences. His expertise as a consultant in these areas
has been sought by both private and public sector policy-makers, and he
is a 1984 recipient of the California Medical Association's Scientific
Award of Merit. Studies conducted by Dr. Ganiats in 1993 led to the public
health policy change requiring hepatitis B immunization prior to entering
the 7th grade (instead of in infancy).
In 1997, he studied the merits of
giving one-on-one instruction to 100 patients about the outcomes associate
with 5 ways to handle colon cancer screening. The diversity of opinions
expressed, among a relatively homogeneous population, implies that patients
can be informed and, so informed, have definite opinions. Colon cancer
is a top cause of cancer mortality in men and women; this gives researchers
important insights into how to improve compliance with colon cancer screening.
Lawrence J. Schneiderman is an internist and noted biomedical
ethicist who has gained particular recognition in recent years for his
seminal work in the area of medical futility and advance directives (living
wills). In the first prospective controlled study of advance directives
he found that, contrary to most expectations, people who sign such directives
to forgo heroic measures under hopeless conditions do not shorten their
lives nor consume less medical resources. He has also conducted one of
the few empirical studies (including the first prospective controlled trial)
of ethics consultations, a new area of medical activity.
is very active in the service arena, providing ethics consultations and
invited talks for a variety of audiences including academics and practitioners
in medicine, law, the judiciary, and philosophy, as well as the lay public.
He organized and chaired a statewide conference exploring the possibility
of establishing standards of care with respect to medical futility.
area of interest is ethical issues in alternative medicine. Dr. Schneiderman
has proposed, from an ethical perspective, that alternative medicine should,
like traditional medicine, be defined by certain goals, principles, actions,
scope of practice, measures of outcomes, and standards of evidence.