Student-Run Clinics Expand Access to Dermatology Care

For diverse patient populations who are historically marginalized within health care, student-run clinics may offer a potentially cost-effective access point to dermatological care. | Image Credit: Gorodenkoff - stock.adobe.com

Dermatology student-run clinics often serve diverse patient populations, including a high proportion of minority racial/ethnic groups, unhoused individuals, and those with limited access to traditional health care, according to an article published in JMIR Dermatology.¹

Student-run clinics aim to improve health care access for underinsured and uninsured Americans. They serve as free primary care options for underserved populations, diverting them from costly emergency department visits.² By providing hands-on experience to medical trainees, these clinics educate and empower the next generation of health care providers to serve vulnerable communities.

These clinics typically offer preventive and primary care services, along with disease management.¹ However, research on the current state of dermatology student-run clinics nationwide remains limited. This study conducted a scoping review to expand upon existing dermatology-focused research.

This review analyzed 31 studies involving 19 student-run clinics across the US. These clinics primarily served minority, homeless, and low-income populations. A significant portion of patients were uninsured and faced language barriers. The study population varied widely, with the proportion of unhoused individuals ranging from 44% to 100%. Black patients comprised 27% to 48% of the populations, while Hispanic patients ranged from 24% to 90%.

The student-run clinics mostly had atopic dermatitis (AD) cases, with a prevalence ranging between 10% and 49%. Other popular cases included acne, fungal infections, benign nevi, psoriasis, and neoplasms like basal cell carcinoma, squamous cell carcinoma, and melanoma.

Frequent diagnoses varied across different age groups, with AD as the most prevalent diagnosis among patients younger than 18 years. Acne vulgaris was most reported among individuals aged 18 to 35 years. Fungal infections were primarily observed in the group aged 36 to 49 years. Xerosis (dry skin) was most often seen in patients 50 to 59 years. Finally, ichthyosis was most frequently diagnosed in individuals 60 years and older.

In student-run clinics with greater populations of unhoused people, higher rates of infectious conditions were identified, such as infestations and bacterial, viral, and fungal infections. Commonly prescribed medications were topical steroids, antibiotics, and antifungals, whereas procedures included excision, shave biopsies, punch biopsies, steroid injections, and wound care.

A major challenge for student-run clinics is ensuring patient follow-up. Telemedicine has shown promise in improving follow-up rates. Barriers to follow-up for underserved populations include language barriers, inflexible work schedules, and limited transportation options.

In countries with universal health care coverage, the necessity of student-run clinics as a primary source of care may be less pronounced.³ This is because the concept of student-run clinics arose as a response to the limitations of for-profit health care systems. While the US possesses substantial medical resources, a significant portion of the population remains unable to access essential health care services. The quality of care provided by student-run clinics can vary significantly depending on the availability of resources and funding, particularly considering that these clinics are primarily operated by medical students rather than fully licensed physicians.⁴

Additionally, patients attending student-run clinics tend to have limited technological capabilities.¹ Unreliable access to mobile web-based devices made it a challenge to create or confirm follow-up appointments among undomiciled patients. One student-run clinic found reminder phone calls prior to telemedicine appointments helped reduce patients’ no-show rates.

Logistic issues involved the seasonal availability of medical students/residents, the rotating supply of students/residents/attendings, and the limited amount of attendings. It was common for biopsy supplies to experience supply chain limitations as well. Notably, generally high rates of patient-reported satisfaction flourished throughout student-run clinics.

The US health care system does not guarantee patient access, which often varies due to systemic inequities, the authors wrote. Student-run clinics offer underserved populations the opportunity to receive evaluations by medical students when they might not otherwise be able to receive a consultation with a dermatologist.

According to the authors, student-run clinics require increased funding for diagnostic and therapeutic resources. Private grants represent a potential source of additional support. In the interim, clinics can enhance their impact through quality improvement initiatives and a focus on high-value care. Continuous education for both students and staff is crucial to adapt care delivery to meet the evolving needs of patients served by these clinics.

Long-term sustainability and patient continuity can be facilitated through integration into a health care system. Telehealth at student-run clinics has become a tool to improve consultation flexibility while allowing clinics to expand their resources to patients who may not have transportation.

The coverage of clinic characteristics across the studies included in this review vary, making comparisons between clinics challenging. The findings may not be generalizable to all dermatology student-run clinics and could have overlooked clinics not yet documented in the literature, potentially underestimating the impact of other free or low-income clinics.

Nonetheless, the review authors wrote, dermatology student-run clinics offer abundant research possibilities, encompassing medical education, patient advocacy, and the delivery of health care services. Undergraduate medical training increasingly incorporates student-run clinics to enhance learning, cultivate cultural awareness, and instill a commitment to volunteerism among future doctors, particularly within underserved communities.

“Our scoping review provides a comprehensive overview of these clinics nationwide, with the hope of encouraging medical students, schools, and dermatology departments to establish and expand such clinics in their own communities,” the study authors concluded.

References

1. Kamat S, Agarwal A, Lavin L, Verma H, Martin L, Lipoff JB. Dermatology in student-run clinics in the United States: scoping review. JMIR Dermatol. 2024;7:e59368. doi:10.2196/59368

2. Rupert DD, Alvarez GV, Burdge EJ, Nahvi RJ, Schell SM, Faustino FL. Student-run free clinics stand at a critical junction between undergraduate medical education, clinical care, and advocacy. Acad Med. 2022;97(6):824-831. doi:10.1097/ACM.0000000000004542

3. Young L. The ethics of free clinics. A Medicine Cabinet. November 23, 2021. Accessed January 9, 2025. https://www.amedicinecabinet.com/opinions-experiences/the-ethics-of-free-clinics

4. Vu A, Hsu AR, Baumel NM, et al. Preventative care in student-run free clinics: a narrative review on feasibility, ethics, and recommendations. BMC Med Educ. 2024;24(1). doi:10.1186/s12909-024-06314-0