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Advances

Students take the lead at Claremont Health Clinic

By Susan Green

Geisel medical students Tyler Giberson (left) and Cody Rissman work with a patient at a student-run health clinic in Claremont, N.H.

This has been the best experience we've had so far in medical school," says third-year student Christine Breuer about managing the Claremont Soup Kitchen Health Clinic. "It's why we went into medicine," adds fellow third-year student Erik Andrews.

Established two years ago by Geisel School of Medicine classmates and Schweitzer Fellows Samantha Batman ('15) and Mazin Abdelghany ('15), the free medical student-run health clinic in Claremont, N.H., brings easily accessible screening and referral services to a population with unmet needs.

With the support of Claremont Soup Kitchen's founder and director, Jan Bunnell, but without many resources, Batman and Abdelghany began seeing patients one Monday evening each month in Bunnell's office, which offered little privacy. Yet, in spite of these circumstances, the medical students managed to gain their patients' trust.

"They made good inroads and were accepted by the community," says their mentor, William Boyle, a professor of community and family medicine. "But they were hampered in a number of ways, the most important being no place to talk privately with patients."

The fledgling clinic needed exam rooms.

By the time Breuer and Andrews took over the management of the clinic the following fall, they discovered that two professional examination rooms had been built courtesy of Bunnell. They quickly stocked the rooms with donated supplies and equipment, including two state-of-the-art examination tables, and asked Boyle to be their preceptor. "The project would not exist without him," Breuer says. "His authority and stamp of approval let everyone know that Dartmouth was committed to this project."

As more soup kitchen patrons began visiting the clinic, Breuer and Andrews expanded the open-door policy to every other Monday during regular dinner hours. When they recruited Tyler Giberson ('17) and Cody Rissman ('17), then first-year students, they were able to see patients every Monday.

"I like that the clinic is entirely run by medical students," Giberson says. "It really allows us to make a difference. With a nice set of protocols in place, it allows us to practice our interviewing and exam skills without overreaching our scope of practice."

Rissman agrees. He, too, wanted a boots-on-the-ground service learning experience, and like Breuer and Andrews, he wanted one that was entrepreneurial. "I knew that there would be an opportunity to shape the new program," he says.

Breuer and Andrews have put their heart and soul into making the clinic a success. They established a collaborative relationship with Valley Regional Hospital in Claremont and with the Good Neighbor Health Clinic in White River Junction, Vt. They created electronic medical records for the health clinic's patients, making it easier to refer patients to physicians at Good Neighbor. And they came to an agreement with Valley Regional Hospital to provide physician oversight during open clinic hours.

"We've had success stories, but as it now stands, there are still unmet needs in Claremont," Rissman notes. "Over the past few months we've found that our reach could be broader. Our biggest challenge is to find a way to reach out to people who need our resources but who don't utilize the soup kitchen."

There's no doubt that it's a challenging population in a tough part of town. And although many patrons have both mental health issues and physical ailments, they hope to recruit and refer patients to appropriate existing services.

"First and foremost, we are here to promote health literacy—to help people understand and manage the conditions they already have," Rissman says.

Giberson and Rissman, who are now managing the clinic, are keenly aware of the necessity of establishing benchmarks to measure the clinic's success. "We need to find a baseline to measure how we were initially and then after three years check to see if our intervention improved health care in Claremont," Giberson says.

One of the great things about projects like this, and about what Geisel does really well, is to focus on preventative medicine—true health care rather than sick care, both Giberson and Rissman note.

Although there's more work to do, Boyle has been impressed by what the students have already accomplished. "It has been gratifying to see that if you give the students free rein to do something, and then let them do it, they'll do a magnificent job," Boyle says. "Just magnificent."


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