Student-run free clinics and complementary curricula

Dear Sir

Pre-clinical students often volunteer at student-run free clinics (SRFCs), where they learn history-taking skills, perform basic procedures, and practice presentations to attending physicians. Recent research indicates that over half of US medical schools now staff SRFCs, which collectively serve tens of thousands of patients yearly (Simpson & Long 2007). In single center surveys, students have endorsed SRFCs as valuable educational experiences that positively influence their attitude toward working with underserved populations (Smith et al. 2012). Yet no surveys to date have investigated SRFCs integration with formal curricula or the complementary curricula that students themselves develop.

Medical students have gained the foundations necessary to care for patients during their preclinical years through classroom instruction, shadowing clinicians, and standardized patient experiences. These formal curricula typically follow the model of skill acquisition outlined by the Dreyfus and Dreyfus model, as students gain responsibilities in accordance with their developmental stages (Dreyfus & Dreyfus 1980). This model has been especially important in medicine, where learners invariably begin as novices whose practice may cause inadvertent iatrogenic harm.

In our recent experience, a complementary curriculum developed by upperclassmen at our institution offered first-year medical students a guide to problem focused history taking, medical heuristics, and therapeutic options. Though well intentioned, these guides could encourage novices to perform intern level skills prior to receiving formal instruction. While early skills-training has been successful, supervision and proper definition of roles will be crucial to the provision of ethical patient care. Future studies should investigate the integration of formal curricula with SRFCs, the complementary curricula that students themselves develop, and the impact of these interventions at SRFCs.