# Assessing the Formal Integration of a Student-Run Free Clinic for People Experiencing Homelessness Into a Medical School Curriculum

## TL;DR

This study examines how integrating a student-run free clinic into medical school curricula improves students' clinical skills and understanding of social determinants of health.

## Contribution

The study demonstrates the benefits of formally integrating student-run free clinics into medical education.

## Key findings

- Common diagnoses included musculoskeletal pain, viral upper respiratory infection, and cellulitis.
- Students showed significant improvement in clinical skills, trauma-informed care, and understanding of social determinants of health.
- Three themes emerged: clinical rotation preparation, independence in a safe space, and exposure to street-side medicine.

## Abstract

Background

Student-run free clinics (SRFCs) are present in many medical schools and help bridge gaps in healthcare access for people experiencing homelessness. Volunteering for SRFCs is a common medical school experience, though it is seldom an integrated component of medical school curricula. This study aims to assess the benefit of formal integration of an SRFC into a medical school curriculum by investigating the common street-side clinic diagnoses and assessing whether clinic participation improved students’ confidence in their clinical skills and navigation of the social determinants of health (SDHs) and trauma-informed care.

Methodology

A retrospective review of medical charts from 2020 to 2024 was completed to understand the common diagnoses seen at the clinic. First-year medical students enrolled in the SRFC as a part of their first-year curriculum from 2022 to 2024 were given pre-tests and post-tests to assess change in confidence across several clinical skills after participation throughout their first year. The results were analyzed by categorization and using Fisher’s exact test. Qualitative responses to assess their experience were also collected in the post-test and reviewed for systematic themes.

Results

The retrospective chart review showed the most common diagnoses were musculoskeletal pain, viral upper respiratory infection, and cellulitis. It also showed that a variety of conditions were seen across many different organ systems. There was significant improvement for all survey questionnaire items, including clinical skills, inter-team collaboration, trauma-informed care utilization, and understanding the SDHs. Three overarching themes reflected students’ experiences after the fact, including preparation for clinical rotations with real-life applications, independence as a medical student within a safe learning space, and exposure to street-side medicine and humanism.

Conclusions

SRFCs play an important role in healthcare delivery to underserved communities and provide numerous benefits to their student participants. Despite the benefits, there is a lack of exposure for medical students as part of formal medical school curricula. This study shows the benefits of SRFCs with improvement in medical students’ clinical skills, subjective readiness for clinical rotations, and ability to integrate whole-person healthcare. Beyond this, it allows students to foster relationships with a vulnerable patient population and develop skills to bring forward in their careers when working with underserved communities, including increased understanding of the SDHs and trauma-informed care. Although limitations exist within this study, further exploration of the unique nature and impact of SRFC integration into medical school curricula is warranted.