Community

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.   

Free Clinic VolunteersThese partnerships 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 Beck, MD, 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, community collaboration).

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 calories.

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.

St. Vincent de Paul Village and UCSD's Family Medicine-Psychiatry Residency Training Program

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.

St. Vincent 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 seeking employment.

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.

Family Medicine Residency: Addressing the Needs of the Underserved in San Diego's Latino Community

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.

The 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 physicians.

Health Outcomes

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.

Medical Ethics

Dr. 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.

Dr. Schneiderman 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.

A new 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.