Orientation/Syllabus for FPM 432
Please read the following from beginning to end. It is important to us that you fully understand the
course requirements and expectations as well as the important role you will be playing at the UCSD
Free Clinic Project as part of this clerkship. Thank You.
The purpose of this 4th year clerkship is to immerse the student in the principles and practice of underserved
medicine in an urban setting, and to teach core knowledge, attitudes and skills in the effective practice of family
medicine in underserved communities.
The learning objectives for this course include the following:
By the end of this clerkship, students will be able to:
1. Identify four barriers to access to health care in San Diego county
2. Describe the current programs for underserved and uninsured individuals and their basic eligibility
criteria including: County Medical Services, MediCal, Family Pact, Healthy Families and Every Woman
Counts.
3. Demonstrate a basic clinical knowledge of the diagnosis, treatment, and management of common
chronic illnesses, including diabetes, hypertension, asthma, depression, and hyperlipidemia, and the
particular challenges to comprehensive care and treatment for uninsured individuals with these conditions.
4. Identify key elements of clinical teaching and practice being a clinical coach of MSI and MSII students
5. Describe the role of Promotoras (health promoters)
6. Describe the role of community and community members in identifying and solving health problems
7. Describe appropriate methods of working with interpreters and learning from refugees and immigrants.
8. Describe and utilize Patient Assistance Programs to provide pharmaceuticals for patients
9. Describe common medical problems in the street homeless, including the treatment and management of
common skin infections and skin diseases
10. Describe resources for mental health and substance abuse care for patients in San Diego County.
11. Identify health education and promotion approaches for underserved communities.
12. State the World Health Organization definition of health and its relevance for underserved
communities.
13. Describe the role of each of the following in care of the underserved:
 Community Health Centers
 Free Clinics
 School-Based Health Centers
14. Define the following terms:
 Empowerment
 Humanistic Approach [including terms: empathy, congruence, positive regard]
 Transdisciplinary
 Vulnerable Populations “Cultural Humility”
15. Identify the importance of life-long reflection activities as an important part of the practice of clinical
medicine.
16. Reflect on models of how to include work with underserved communities as part of their future practice
of medicine.
17. Recognize the role of the physician in patient advocacy.
Clerkship Activities:
You will be working at several sites throughout your rotation. Please pay close attention to your schedule since each
day may be different. This rotation will give you relevant skills and knowledge to work with underserved
communities by working primarily at the UCSD Student-Run Free Clinic Project and also various alternative
experiences which may include working at San Ysidro Community Health Center, Mobile Health Clinics, the Health
and Faith Clinic with Dr. Margaret McCahill, a high school clinic with Dr. Natalie Rodriguez or Dr. Trejo,
Comprehensive Health Center with Dr. Anne Kaufhold (please wear a lab coat at this site with appropriate business
attire), Asian Pacific Health Center, and a community field trip and didactic session with Dr. Ruth Heifetz. You will
also be meeting with Dr. Ellen Beck for two sessions during your one month rotation where you will learn about
access to care in San Diego and reflect on your experience as a teacher and working with underserved populations.
There will also be didactic sessions with Dr. Sunny Smith, Dr. Michelle Johnson, and Dr. Natalie Rodriguez that
cover core primary care topics such as Diabetes, Hypertension, Hyperlipidemia, Depression, Asthma, Skin Disease,
and Health Care Maintenance.
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ORIENTATION AND STUDENT ROLES FOR FPM 432 AT THE UCSD STUDENT-RUN FREE CLINIC
PROJECT
Introduction
Welcome or welcome back to the UCSD Student-Run Free Clinic Project. During your sessions at the clinic you
will learn about many of the joys and challenges of community medicine and healthcare of the underserved by
becoming an active participant at the student-run free clinic project. You will be working closely with your
classmates, students in their 1st, 2nd and 3rd years, faculty physicians, nurse practitioners, pharmacy students,
acupuncture students and patients. You will also get to know our community partners and their programs.
MISSION STATEMENT
The free clinic mission statement, written by the students, is:
The UCSD Student-Run Free Clinic Project, in partnership with the community, provides accessible, quality health
care for the underserved in respectful environments, in which students, health professionals, patients, and
community members learn from each other.
We seek to sustain health through: Free Medical and Preventive Care, Health Education, and Access to Social
Service
Core Values: Respect, Trust, Learning, Excellent, Repose for Diversity, Communication, Empowerment, Integration,
Community.
History and Services (Student-Run Free Clinic Project)
The UCSD Student-Run Free Clinic Project was started in January 1997 at the Pacific Beach Methodist Church in
partnership with Harvest for the Hungry, a non-profit organization that worked with the homeless. Organized and
operated by medical students under the supervision of volunteer faculty physicians, the Free Clinic was established
to provide high quality, basic medical care and social service referrals to the underserved individuals of San Diego
County while offering a unique educational setting where students can learn about the special needs and challenges
of community medicine with the underserved.
The Pacific Beach clinic operates in conjunction with the weekly Wednesday night meal provided by the United
Methodist Church. The PB clinic also offers dental services, run by pre-dental student volunteers and volunteer
dentists, and acupuncture through the free clinic run by students and faculty of the Pacific College of Oriental
Medicine.
The second clinic site at the First Lutheran Church in downtown San Diego opened its doors in fall 1997 in
collaboration with the Third Avenue Charitable Organization (TACO). The clinic coincides with a meal program
for homeless people at the church on Monday nights. The dental and acupuncture clinic also operates at the
downtown clinic. Our core partner at the church is TACO (Third Avenue Charitable Organization), which provides
social work consultations, counseling and coordinates our efforts. California Western School of Law operates a legal
clinic at this site.
The third clinic site opened in fall 1998 at Baker Elementary, an inner city public school in Southeast San Diego.
The Baker clinic mostly serves Latino and some African American families from the surrounding community.
Baker clinic has a strong women’s health program and a community outreach and health education program led by a
health promoter from the community, as well as dental and orthodontic services.
The Free Clinic has grown into a large project, virtually entirely designed, operated, and governed by students.
Leadership student quote: “We serve on and direct various committees, participate in the day-to-day operation of the
clinics, raise money, do publicity, and make joint decisions on the programs and policies of the clinics. Most
students have found that participating in one or several of the clinic’s management activities has been a great
learning experience, has deepened their understanding of the clinic overall, and has given them valuable practical
and leadership skills that come in handy for their clinical training years and beyond. If you would like to volunteer
to work on a specific committee or have an idea for a project, please let us know – we welcome your on-going
participation.”
FPM 432 – Student’s Role at the Student-Run Free Clinic Project
At the free clinic sessions, you will perform clinical duties (seeing patients). On the days you see patients; you will
often, although not always, be paired with a first or second year student to conduct patient interviews and basic
physical exams. Please let the MSI or II do as much of the encounter as they can with you, the clinical student,
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acting as a coach. All patients must be presented to the attending physician, who must see all patients, supervise
their care, and sign their charts. You will also help the MSI/II write up their note after you have reviewed the case
with the attending.
As a fourth year student, the first and second years will look up to you. You are now in the role of coach and
teacher. Please show patience and respect to them and the patients. Please teach the importance of empathy, trust,
and the doctor-patient relationship. Please reinforce the importance of the social history. Please help them be
thorough, addressing health education, prevention, and management issues. Please ensure that lab tests ordered are
truly needed and that medications are recorded and dispensed accurately and that all records, data forms are
appropriately and legibly completed. Please ensure confidentiality. Please create a safe and trusting environment
for yourself and the patient. If you are with a mentally ill patient, please keep the door open. If a patient is at all
disruptive, please seek the help of the patient liaison and clinic manager at each site. Please go to your cars in the
evening with a “buddy”.
Clinic schedules are as follows:
Downtown Clinic
Monday
5:30-10:00 pm and Friday 9:00 a.m – 1:00pm.
Baker Clinic
Tuesday
1:00-6:00 pm and Thursday 8:30am – 12:30pm.
Pacific Beach Clinic
Wednesday 6:00-10:00pm
Course Requirements for FPM 432
In order to pass this clerkship, you are required to:
1. Attend all clinical and teaching sessions. If you cannot attend a session due to illness or personal
responsibility, please notify Carol Whitener so we can reschedule your assigned experience or arrange for you to
make-up the time.
2. Hand the following items in:
a). Attendance Record
b). Answers to the designated questions
c). Summary/Reflection paper.
d). Course evaluation on paper or online
Attendance Record
Students keep an attendance record during the month documenting the days they participate at the clinic. You
may have your schedule signed by the attending physician or a clinic manager. This record must be turned in at
the end of the rotation.
Absence Policy
Students are not permitted to miss any days of this rotation except in special circumstances. Please note that
if you have already received your clerkship schedule from our office, you will be responsible for
notifying your preceptor of any scheduling change. You must also notify Carol Bloom-Whitener
by phone or email.
1) Residency Interviews – A student is permitted up to a maximum of three days of scheduled absences per one
month block rotation for residency interviews scheduled during interview season. Interview dates must be
submitted to Carol Whitener two weeks before the clerkship begins so that she may plan your schedule
accordingly.
2) Personal or Family Emergency - To request an absence due to unforeseen circumstances, the student must
notify Carol Whitener as soon as possible. Her contact information is listed above.
Making up for absences
If a student has missed any days, a written plan will have to be submitted to Carol Whitener regarding how these
absences will be made up by the end of the rotation. Carol must approve this plan. Make up clinic sessions
should be completed as soon as possible, preferably during the following month. A maximum amount of three
months will be allowed to make up absences. When you attend clinic to make up for a missed date, the attending
physician or clinic manager must sign an attendance sheet to verify that you attended clinic. All missed days
must be made up in order to receive a passing grade for FPM 432.
Journal & Reflection Paper
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We would like you to write a brief reflection paper, approximately 3-5 pages. The paper should include
descriptions of 2 patient encounters, with an emphasis on how you felt about those encounters and what you
learned, as well as your experience as a teacher/coach. You may also want to include learnings related to issues
of access to care and about yourself as a future physician. Feel free to be creative in the writing and presentation.
Papers are due on the last day of the clerkship. You may use this paper to describe the journey of your learning
at the free clinic and medical school, both as a person and as a chosen professional and teacher in relation to
the underserved community. No references are required for this paper.
Reading List
In order to be an effective primary care clinician, it is importan to understand that a large part of how we practice is
based on guidelines provided by national organizations that are revised over the course of time as more data
becomes available. These guidelines are always being revised. Please read the following guidelines that are
applicable to primary care. The last item in the reading list is a journal article that summarizes the UCSD StudentRun Free Clinic Project.
1. Cholesterol Treatment Guidelines:
(Please refer to all three to see how guidelines were updated in 2001, 2004, and 2006 based on new data.)
-ATP III 2001. (JAMA. 2001;285:2486-2497). Full report: (Circulation. 2002;106:3143-3421.)
-ATP III Update 2004. Implications of Recent Clinical Trials for the National Cholesterol
Education Program Adult Treatment Panel III Guidelines. (Circulation. 2004;110:227-239.)
-AHA/ACC Guidelines for Secondary Prevention for Patients with Coronary and Other
Atherosclerotic Vascular Disease: 2006 Update. (Circulation. 2006;113:2363-2372.)
2. Hypertension Treatment Guidelines
-JNC 7: Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation,
Treatment of High Blood Pressure. (JAMA. 2003;289:2560-2572.)
and
3. American Diabetes Association Clinical Practice Recommendations 2008. ( Diabetes Care. 2008 31.)
4. The Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma — Full Report,
2007. Available at: www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf
5. "The UCSD Student-Run Free Clinic Project: Transdisciplinary Health Professional Education". Journal of
Health Care for the Poor and Underserved. Volume 16: Number 2. May 2005: 207–219.
Evaluation Criteria
 Please see the attached evaluation form that is used to grade students’ performance on this rotation. It is
completed by the core Free Clinic faculty members for each student at the end of the rotation.
 Students are graded on their ability to obtain a complete history and physical exam, verbal presentation
skills, note writing, and ability to form an accurate assessment and plan. Their clinical skill set and
knowledge base is judged based on repeated interaction with core continuity faculty members.
 Students are also graded on their ability to interact well with patients, their families, and other members of
the health care team.
 Knowledge and comments during reflection and discussion sessions with the course director and faculty
throughout the clerkship are also used in assessing the students.
 Students must complete all of the course requirements (see below – question 4).
 In order to achieve a grade of honors on this rotation, a student must show outstanding clinical knowledge,
organization, interpersonal skills, and demonstrate an understanding of the barriers facing our underserved
patients.
A message from Dr. Beck:
It has been very satisfying for me to observe the enthusiasm and involvement of the students as you fulfill the dream
of creating a student-run free clinic. By taking this clerkship, you will become part of the ongoing life of the clinic.
The clinic's future depends on committed, involved students who will share responsibility for the running of the
clinic. These roles range from the fascinating to the mundane, but all are needed to keep the clinic going. Students
find they are learning things they never expected, including how to be a clinic coordinator, how to set up referrals
for social programs, how to manage patients with very limited technological support, how to set up a lab and keep
samples appropriately, how to get free medications for poor patients, and how to help someone by simply listening
and showing them respect when you feel helpless in the face of their problems. The bottom line in this clinic is
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respect and trust. By showing respect to our patients and each other, to our colleagues and staff, we build trust and a
sense of community. Also, please be prudent regarding issues of confidentiality and safety.
If you would like to be involved in the clinic’s leadership and administration after your clerkship time is over, please
let us know. We need the help. Also, you are welcome to be involved clinically throughout the rest of the year. For
now, I wish you an enjoyable and productive month. I think you will find that you will learn much from your
patients, that they too will become your teachers, and that this experience will reaffirm your choice of a career in
medicine.
In these communities, the patients have given us their trust and respect. Please uphold the values and high quality of
care of the UCSD Student-Run Free Clinic Project. These patients may perceive you as their doctor. Please respond
to that with the appropriate level of humility and remind them that you are still a student and give them the best,
highest quality of care, respect and thoroughness that you can. We are glad you are with us. There will be assigned
readings throughout the rotation that we will forward to you at a later date. If you have any questions regarding this
rotation, please feel free to contact our office. Have a wonderful month.
Thank you.
Ellen Beck, MD
Faculty Advisor, UCSD Student-Run Free Clinic Project
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Contact Information:
(Actual syllabus includes a section of contact information, clinic sites, and directions.)
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