Tulane University Student-Run Clinics: A Vital Resource for New Orleans

Introduction

Tulane University School of Medicine (TUSOM) boasts a robust network of student-run clinics that play a critical role in providing healthcare to underserved populations in New Orleans. These clinics not only address the healthcare needs of vulnerable communities but also offer invaluable learning experiences for medical students. This article will explore the history, operations, and impact of these clinics, highlighting their significance in the community and within medical education.

History and Evolution

Like much of modern New Orleans, Tulane University School of Medicine’s (TUSOM) student-run clinics in their current form were founded in the aftermath of Hurricane Katrina. In the wake of this devastating event, students collaborated with community centers and pop-up clinics to deliver patient triage, basic healthcare services, and referrals to communities that had lost almost all healthcare services. From this initial response, an ad-hoc system of clinics grew and expanded, driven by the initiative of Tulane students and responding to the needs of medically underserved communities across New Orleans.

The Student Clinic Council (SCC)

Today, the SCC oversees all of TUSOM’s extracurricular clinical experiences, including over 26 student-run clinics in 13 locations across New Orleans. The Tulane University School of Medicine Student Clinic Council seeks to facilitate open communication and synergistic interactions among the leadership teams of student-run clinics located throughout the city of New Orleans. This council will strengthen the quality of the services each clinic provides to its respective patients, in the hopes that these improvements better the overall quality of and access to healthcare for all utilizing those clinics. These clinics are split between preceptor model clinics, screening model clinics, tuberculosis testing, vaccination clinics, HIV/HCV testing clinics, and health education.

Types of Clinics and Services Offered

Tulane's student-run clinics offer a diverse array of services tailored to the specific needs of the communities they serve. These services span from primary care to specialized treatments, health education, and preventative screenings.

Primary and Urgent Care Clinics

Several clinics focus on providing primary care services, including general check-ups, physical examinations, and management of chronic conditions. Examples include:

Fleur de Vie Ruth Fertel Clinic: Operating jointly with Access Health Louisiana, this clinic delivers primary care to an underserved patient population, focusing on affordable, high-quality care and innovative learning environments for students. Services include check-ups, health screenings, physicals, and patient education, with HIV testing and counseling being rolled out. Spanish interpreting services are also available.
Ozanam Inn Student-Run Clinic: In partnership with Ozanam Inn, a homeless shelter, this clinic aims to improve healthcare access for the diverse and underserved population in New Orleans. It provides in-house clinical services, including primary care, TB testing, HIV testing, and flu vaccination, as well as referrals for specialized care.
Luke's House: Provides health care for New Orleans’s large Spanish speaking population. This clinic offers services such as: general checkups, screening for hypertension and diabetes, prescription assistance, vaccinations for Influenza, Tdap, and Pneumococcus, and referrals to other healthcare services. This clinic also provides eye care to the surrounding community in the form of an ophthalmology clinic by appointment.
Fleur de Vie Clinics: Fleur de Vie operates in affiliation with Tulane Community Health Centers and is recognized as a patient-centered medical home by the National Committee for Quality Assurance. Patients seen at the Fleur de Vie sites typically are uninsured and have limited access to urgent or primary health care. The sites work closely with their weekday affiliates to promote continuity of care and coordinate referral services. Urgent healthcare services are provided by volunteer medical students and internal medicine residents and attending physicians.

Specialty Clinics

Some clinics offer specialized care, addressing specific health concerns or serving particular populations. Examples include:

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Fleur de Vie NOLA East Clinic: Hosted at NOELA Community Health Center, this clinic offers specialty care, including Hematology, Endocrinology, Nephrology, Cardiology, Hepatology, Neurology, and Gastroenterology.
Luke's House Ophthalmology Clinic: Provides eye care to the surrounding community in the form of an ophthalmology clinic by appointment. The ophthalmology clinic first began operation in January 2016. Since that time, the clinic has expanded to providing eye care twice a month to all patients on an extensive waitlist.

Screening and Prevention Programs

Screening and prevention programs are a crucial component of the student-run clinics, addressing public health concerns and promoting early detection and intervention.

HIV/Hepatitis C Testing Program: Recognizing New Orleans' high rates of HIV infections and Hepatitis C, this program offers testing, counseling, and resources linking individuals to care and prevention services.
TB Testing Program: Addressing the higher-than-average TB rates in New Orleans, this program provides testing and referrals to treatment programs, aiming to stem the spread of TB.

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Clinics Serving Specific Populations

Several clinics are tailored to serve specific populations with unique healthcare needs.

Bridge House Wednesday Clinic: Founded in 1999, this clinic provides primary health care to men living and participating in the rehabilitation program at Bridge House, a substance abuse rehabilitation facility. Services include intake physical examinations, tuberculosis testing, and treatment for acute and chronic medical needs.
Grace House: A partner of the Bridge House rehabilitation center, provides both long and short-term residential treatment programs for women with drug and alcohol addictions, regardless of ability to pay. This newly established student-run clinic currently provides these women with their state-mandated intake physicals, prescriptions, and out-of-clinic referrals.
New Orleans Mission Clinic: Housed in New Orleans’ largest homeless shelter, the goal of the clinic is to treat subacute illnesses and to serve as a bridge to established resources in the city for homeless and indigent populations. The New Orleans Mission Clinic is a student run clinic that expanded its services in 2015 to include a weekly precepted clinic staffed by Internal Medicine residents in addition to its weekly flu vaccination, TB, HIV and Hepatitis C testing services.
Tulane Street Health Response: This initiative brings medical services directly to the unsheltered homeless population, providing evaluation, treatment, and referrals to primary and specialty care.
Bethel Colony South: Bethel Colony South is a long-term, substance abuse rehabilitation facility for men. Clinic runs biweekly on Tuesdays or Fridays, and the topic of the clinics varies. Examples of clinic topics include: hypertension & diabetes, STIs and their prevention, linkage to care, and mental wellness. At the clinic, T1 and T2 students interact one-on-one with a Bethel resident to provide personalized counseling and come up with a plan of action to address the resident’s health concerns. It is a wonderful opportunity to practice personalized medicine, motivational interviewing, and health education and counseling.

Clinic Operations and Structure

The Tulane student-run clinics operate through a collaborative model involving medical students, faculty physicians, and community partners.

Student Roles and Responsibilities

Medical students play a central role in the operation of the clinics. They are primarily responsible for managing operations and taking histories, performing examinations, and developing treatment plans. First- and second-year students begin the initial intake and physical examination and present to a third- or fourth-year student who further guides the assessment. Students volunteer a total of 1478 shifts for 4508 hours at the student-run clinics and associated programs.

Supervision and Oversight

Physicians supervise all encounters by examining all of the patients and approving treatment plans. After seeing a patient, teams will present to the attending physician and work together to develop their assessment and treatment plan.

Interprofessional Collaboration

Many clinics involve interdisciplinary teams, including social work and public health students, who provide services such as health education, psychosocial counseling, and referrals to community resources.

Service Learning

All student-run clinics are approved service learning programs through the Foundations in Medicine course for preclinical medical students. The service learning program is designed to promote immersion in community-based health care and an understanding of social determinants of health, especially for vulnerable patient populations. Patients themselves are valuable teachers and are the primary reason for required clinic-based service learning. First- and second-year students learn from their peers and attending physicians about medical history and physical examination, and third- and fourth-year students learn about developing assessments and plans to meet patient needs that often are fraught with both social and medical challenges. In the case presentation program, clinical students mentor preclinical students on translating clinical findings to differential diagnoses and creating treatment plans. A total of 319 (87.6%) first- and second-year students reported earning service learning hours at one or more of the student-run clinics between August 1, 2010 and May 31, 2011. Medical students are required to self-report duration and location of service learning experiences through an Internet-based system to receive academic credit. Student leaders of service learning programs review these records for accuracy before the information is submitted to the Foundations in Medicine course coordinators.

Impact on the Community

The Tulane student-run clinics have a significant impact on the health and well-being of the New Orleans community.

Addressing Healthcare Disparities

Each clinic is focused on providing free services to help meet the basic health needs of a wide variety of New Orleans area patient populations that are known to experience disparities in health and healthcare access. These clinics provide medical care in the context of underlying social issues such as poverty, substance dependence, mental health issues, and unstable housing status. By providing services for community members who experience difficulties accessing care because of these competing factors, these clinics directly address the local population-specific barriers to health care.

Patient Demographics and Needs

From January 1, 2010 to July 31, 2011, the clinics collectively saw 859 patients for a total of 1455 visits. The majority of patients seen at two of the clinics (Bridge House Wednesday Clinic, Ozanam Inn Weekend Clinic) were men, whereas slightly more than half at the two Fleur de Vie clinics were women. This observation is reflective of the fact that the Bridge House Wednesday Clinic and Ozanam Inn Weekend Clinic are located in community-based organizations that serve men either predominantly or exclusively. The patient populations of the clinics were racially and ethnically diverse, with the majority of patients seen at all of the sites being African American, followed by white, Hispanic, and Asian. Fleur de Vie in New Orleans East clinic opened in January 2010 with the intention of serving a largely Vietnamese population, as reflected in the data.

Common Health Issues Addressed

A wide range of chief complaints from patients across the clinics was recorded, with the most visits for medication refills, musculoskeletal pain, and upper respiratory complaints. In addition, a high proportion of patients were referred to primary care facilities, especially at Fleur de Vie at Covenant House, Fleur de Vie in New Orleans East, and Ozanam Inn Weekend Clinic. These findings highlight that student-run clinics may help lower barriers and facilitate access to primary care, including the maintenance of care plans. The student-run clinics help patients navigate the system through targeted referrals, detailed instructions, and collaboration with the staff of community partner organizations. Another common reason for seeking care was blood pressure and glucose checks. Hypertension and diabetes management were some of the most common counseling and health education topics. Furthermore, antihypertensive medications often were prescribed during patient visits.

Mental Health Services

New Orleans continues to recover from the mental health implications of Hurricane Katrina, with psychological disorders such as depression and anxiety still affecting many individuals. Studies have shown that student-run clinics can offer mental health services that can meet or even exceed the quality of treatment provided to insured populations. The Tulane clinics were able to address mental health issues using several strategies. For example, Fleur de Vie at Covenant House has a dedicated team of medical students that provides mental health screening and referral services. At Ozanam Inn Weekend Clinic, social work volunteers screen for psychological disorders, refer as necessary, conduct psychosocial counseling, and collaborate with case managers at the homeless shelter for continuity of care.

Impact on Medical Education

The student-run clinics provide invaluable learning experiences for Tulane medical students, complementing their classroom education with hands-on clinical experience and exposure to diverse patient populations.

Clinical Skills Development

Students gain practical experience in taking medical histories, performing physical examinations, developing treatment plans, and managing patient care.

Understanding Social Determinants of Health

The clinics expose students to the social determinants of health and the challenges faced by underserved populations, fostering a deeper understanding of the complexities of healthcare delivery.

Professional Development

Through their involvement in the clinics, students develop essential professional skills such as teamwork, communication, leadership, and cultural competence.

Aims and Objectives

The Tulane student-run clinics aim to address similar educational and service-based objectives to reach underserved populations in settings that are culturally appropriate and accessible.

Challenges and Opportunities

Despite their many successes, the Tulane student-run clinics face challenges such as limited financial resources and a shortage of volunteer physicians. The individual student-run clinics and the Interclinic Council, a collaboration among all four clinics, attempt to address these issues through fundraising events, publicity efforts, grant applications and formalized institutional support. These limitations of the clinics include limited financial resources and shortage of volunteer physicians.

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