UCSD Student-Run Free Clinic Project

and

Fellowship in Underserved Health Care

A Trans-Disciplinary Model

Ellen Beck, MD

ADEA 2011

Goals

Need

Programs

Learnings and Next Steps

Need for adult restorative dental care with

the underserved

53 million need medical care

108 million without dental care

( 2002 Surgeon General Report)

Now, many, many more….

Health Reform Bill:

Doesn’t address adult dental care

California and other states: Denti-Cal eliminated

Need for transdisciplinary training

Medical Training: Medical Students at UCSD

receive 2 hours of oral health training

thoughout four years and one of those hours is

elective.

E.g. do not consider dental infections when a

person has diabetes that is out of control

History UCSD Student-Run Free Clinic

Project

1997-First site

Now Four Sites

2 churches, 2 inner city elementary schools

Community partners, passionate students, faculty leadership

Provide free high quality access to health care for uninsured people who fall through the giant holes in San Diego’s very limited safety net

Started as medical clinic, after several years, we realized that 40% of patients had stated unmet oral health needs

2002 started Dental Clinic, students, community partners, volunteer dentists and an orthodontist

UCSD Student-Run Free Clinic Project

UCSD Student-Run

Free Clinic Project

We are committed to providing free high quality health care to underserved communities of San Diego OUR MISSION

The UCSD Student-Run Free Clinic Project, in partnership with the community, provides accessible, quality healthcare for the underserved in a respectful environment in which students, health professionals, patients, and community members learn from one another.

Dental Director

Dr. Irvin Silverstein

Dr Silverstein and the students have won

numerous awards for humanitarian service and

educational programs including the ADA

Golden Apple Award

Core Philosophy

Empowerment

Humanistic

Community as Teacher

Trans-disciplinary

Disciplines involved at the Free Clinic

Project

Medical

Dental

Pharmacy

Social Work

Law

Acupuncture

Health Promotion

Mental Health

Pre-dental Society

San Diego doesn’t currently have a school of

dentistry

Clinic is staffed administratively by trained

pre-dental students and care is provided by

Volunteer Dentists and

Fellows in Underserved Dentistry, all of

whom are appointed as Community Faculty in

the School of Medicine

Dental Services

3 sites, Pacific Beach (church), Downtown( church), Southeast San Diego( inner-city elementary school,serving the community)

7 clinical half-day or evening sessions a week

Restorative Dentistry: Not poverty dentistry

Services include:

Primary Care Dentistry

Specialty Dentistry

Supplies and Labs are donated or purchased by us at low cost through donations we receive

Equipment is acquired through fund-raising and donations

Pacific Beach United Methodist Church basement-

First site of the free dental clinic project

Patient Population 2000 patients in all

1000 medical patients

Over 85% have a chronic illness, including hypertension, diabetes, hyperlipidemia, asthma, and depression

Do not qualify for access to care in San Diego’s very limited safety net programs

51% Latino, 30% Caucasian, 19% African American, 7% Asian

51% female

25% street homeless

One of our Clinical Goals: Refer all medical patients for a on-site dental visit, especially diabetics

Medical student education re oral health UCSD Student-Run Free Clinic Project

105 of 120 First Year medical students take a one quarter elective to work at the free clinic project.

This includes:

a session on oral health and diagnosis

Weekly Reflection

On-site weekly reminders of the importance of dental health, role of dental health in diabetes, and working in the same setting as the dental team

Fourth Year Medical Students

80 of 120 Fourth year medical students take a four week block clerkship

They receive the same as above and a session on fluoride varnish

They learn to be clinical coaches of the junior students

All care is directly supervised by faculty from the school or community.

Student Need

Students arrive with passion, compassion, and

a desire to make a difference

Medical Students at PB Site

Pre-Dental Students

Work at a single site, taking on a variety of roles

Train in Dental Assisting, Xray, and Professionalism

Assist volunteer dentist faculty and dental

fellows/faculty who provide the care

Attend sessions with Dental Deans from around the

country to learn about different dental schools and

professions and meet role models

Dental Clinic Project Statistics

(Between 2002 - 2011)

Have provided over $3.2 million worth of free

restorative dental care

Students volunteered over 49,000 hours in the

clinics

Dentists volunteered over 6,400 hours

Our clinics had over 9,300 patient visits

Have seen over 1,500 new patients

Fellowship in Underserved Dentistry

Started with Fellowship in Underserved Medicine

Expanded to Underserved Health Care, specifically

Underserved Dentistry

9 fellows, of whom 2 have been in dentistry

1-2 years

Half to full time- clinical work, teaching,

administrative, help to run the free clinic project

All 9 working with underserved communities

Dental Fellows/Faculty

Dr. Sussi Yamaguchi

Dr. Randall Taylor

National Faculty Training

Addressing Health Needs of the

Underserved 135 Medical School Faculty

From all stages of career from young faculty, deans, residency directors, department chairs: 27% from underrepresented minorities in the health professions, 30 states

3 weeks over a year with followup

Goals: Community Partnerships, faculty development, professional renewal

Outcomes: pre-post changes in all 35 parameters, including being able to design curricula addressing issues of culture and race, write grants, develop promotora programs, etc

Outcomes after First 53 participants-10 new free clinics, 20 new residency curricula/rotations in underserved/community medicine, etc.

Other dental programs through the Pre-

Dental Society

Dental Students: Relationship with other

dental schools so that dental students do

rotations with us, special programs

Global Health: Mercy and Comfort Missions,

Navy

Dental Health Ambassadors: Teaching healthy

behaviors in elementary schools

Lessons learned and next steps

Our professions need to work more closely together and train more closely together for the benefit of the patient

Effective mechanisms include: Transdisciplinary training in student-run free clinic projects and other community projects

Clerkships

Residency, Fellowships in Underserved Healthcare

Faculty Development-Discipline and Collaborative

Philosophy that is integrated throughout training: Humanistic, empowerment, community as teacher, patient-centered

Societal issues:

Access to Care, Barriers to Access, Social Determinants of Health,

“Toothlessness leads to joblessness” Policy and health reform: Access to adult dental care

Orthodontics included in SCHIP/Healthy

Families programs

Restorative, not Poverty Dentistry

Transdisciplinary training

Diabetes, heart disease, oral cancers, importance of hygiene, communication skills, depression, self-worth, value of co-training

\

Conclusion: Programs such as

Student-Run Free Clinic Projects, Pre-Dental Society,

and Fellowships in Underserved Dentistry

Offer opportunities for students, residents, fellows, clinicians:

To have a sense of ownership in the health care of their patients

To experience satisfaction of making a difference

To recognize issues of access to care in the nation

To help create and become part of the solutions to the problems of lack of access to restorative oral health care for underserved communities

To become healers and teachers

To keep the passion for service alive throughout their training and career ( Pipeline)

Websites and contact information

http://vimeo.com/11059089

IRVINE AWARD VIDEO ABOUT THE FREE CLINIC PROJECT

meded.ucsd.edu/freeclinic/

FREE CLINIC WEBSITE

http://fdc-pds.ucsd.edu/

DENTAL FREE CLINIC AND PRE-DENTAL SOCIETY WEBSITE

ebeck@ucsd.edu

Q and A, Discussion

THANK YOU!