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Chapter 23 The Promise Clinic: A Service-Learning Approach to Increasing Access to Health Care Manuel Jimenez Jennifer Tan John Babineau Jennifer Jimenez Todd Billet Charlene Flash Steven J. Levin Bernadette West Alfred F. Tallia The Homeless and Indigent Population Health Outreach Project (HIPHOP) was founded in 1995 by medical students at the University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School (UMDNJ-RWJMS) to add a community-based service-learning component to their curriculum. The project offered medical students the opportunity to interact with the community through health education workshops, shadowing opportunities at local community health centers, and diverse outreach projects. Members of the HIPHOP leadership committee were disappointed that the 2003 medical school curriculum offered no opportunities for medical students to use their clinical skills directly to serve the community, few opportunities to learn Manuel Jimenez, MD, MS, is a fellow in developmental behavioral pediatrics at the Children’s Hospital of Philadelphia. Jennifer Tan, MD, is an associate physician and instructor in dermatology at Brigham and Women’s Hospital, Harvard Medical School. John Babineau, MD, is a fellow in pediatric emergency medicine at New York Presbyterian Hospital, Columbia University Medical Center. Jennifer Jimenez, MD, is a fellow in pediatric gastroenterology at Alfred I. duPont Hospital for Children, in Wilmington, Delaware. Todd Billet, MPH, is a clinical science specialist with the renal division at Sanofi. Charlene Flash, MD, is a clinical fellow in medicine at Beth Israel Deaconess Medical Center, Harvard Medical School. Steven J. Levin, MD, is an associate professor of family medicine and community health at the Robert Wood Johnson Medical School and medical director of the Eric B. Chandler Health Center. Bernadette West, PhD, MA, is an associate professor in the School of Public Health at the University of Medicine and Dentistry of New Jersey. Alfred F. Tallia, MD, MPH, is a professor and chair of the Department of Family Medicine and Community Health, RWJMS. 234 Jimenez, Tan, Babineau, Jimenez, Billet, Flash, Levin, West, and Tallia as a team, and little opportunity for a continuity experience with patients. Additionally , students recognized that, while physicians are called upon to be altruistic, knowledgeable, skillful, and dutiful, they needed more guidance in professionalism , and that community-based experiences can serve as the basis for such guidance . These students believed a partnership could be formed with the community to address existing health issues that would also enable them to learn from the community . Recognizing that health care is only one aspect of health, a group of firstyear medical students set out to understand better the diverse set of problems facing the New Brunswick, New Jersey, community, especially those involving health care. Seventeen percent of families and 27% of individuals in New Brunswick live below the federal poverty level. Two of New Brunswick’s three largest employers are university hospitals, yet citizens still have difficulty getting health care. New Brunswick is filled with organizations and coalitions dedicated to identifying needs and mobilizing and providing social services. Elijah’s Promise, one of these community organizations, helps people with low incomes by providing nutritious meals, a broad range of social services, culinary arts training, and health screenings integrated with other services. Medical students became active in Elijah’s Promise and held several meetings with its administration to learn more about the problems faced by clients. Access to primary health care by clients at the soup kitchen was identified as a major problem. So, in 2004, students initiated an institutional review board–approved survey to investigate health care access problems among clients of the Elijah’s Promise Soup Kitchen. The survey instrument included questions adapted from the Medical Expenditure Panel Survey. The most critical finding was that approximately one-third of the respondents did not have a regular source of care. To address this problem, medical students worked with the administration of Elijah’s Promise, the medical director and administrative staff of St. John’s Family Health Center (a clinic operated by Catholic Charities), the RWJMS senior associate dean of community health, and more than 15 faculty members from the departments of family medicine and internal medicine to develop the Promise Clinic, the RWJMS student-run continuity clinic. Intervention The Promise Clinic directly combines the efforts of academic medicine with those of a community social service organization to provide continuity health care. The clinic is led by a group of student volunteers from each class (figure 23.1). This ensures continuity despite students graduating each year. The student leaders are...

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