CHIP bridges gap between classroom and real-world experience
Wayne State University’s health care programs have long recognized the need for an interprofessional approach to learning and bridging the gap between the classroom and real-world experience, says Justine Gortney, Pharm.D.. Gortney is associate professor and director of assessment for Pharm.D. and pharmaceutical sciences in the Eugene Applebaum College of Pharmacy and Health Sciences (EACPHS), as well as one of the first faculty volunteers for Wayne State's Community Homeless Interprofessional Program.
When the Cathedral Church of St. Paul in Detroit approached the School of Medicine in late 2013 about providing basic medical care and knowledge to the homeless community, the school recognized an important opportunity. The School of Medicine enlisted EACPHS and the School of Social Work, and formed CHIP. The first student-run clinic took place in March 2014 and has been recurring every third Sunday, following a weekly breakfast the church hosts for the homeless.
From providing blood pressure medication, counseling and routine physical evaluations to community recourse education and bus passes, CHIP provides much needed healthcare to a community with traditionally unreliable access — a community that tallied up to 1,965 during Detroit’s annual “point-in-time count” of people living on the street or in shelters on January 30, 2019.
“In Detroit, there’s a large homeless population, and to work with them is why I’m here,” says Adi Zaclli, a second-year medical student.
During the church service, volunteers gather in a back room, where they’re briefed on “issues facing the Detroit community, like how it’s a food desert,” Zaclli says. “We talk about how and where to help the patients get a more balanced diet, discuss some of the non-profits running community gardens, pop-up markets and free soup kitchens.”
And of course, they discuss how to approach and diagnose the patients.
“White-coat syndrome is real,” says Samantha Brydges, who recently graduated with her M.S.W. and decided to continue volunteering with CHIP afterward.
The homeless’ history with medical professionals is often tumultuous, so it’s important for CHIP volunteers to foster trust. The clinic’s no-coats policy helps, Brydges says; volunteers wear Wayne State shirts and street clothes.
After the service during breakfast, students visit, talk and ask the homeless how they’re doing.
“Sometimes, the most important thing we offer is a listening ear,” Gortney says.
Those who identify a medical need are asked to complete a short form with a student, then led to a triage station while the group of volunteers goes over interview questions in a private room.
During a single session, each patient meets with a student from medicine, physical therapy, pharmacy and social work. Faculty volunteers and local physicians are on standby to field any questions or concerns.
Commonly encountered conditions include diabetes, mental health issues, chronic pain, hypertension, respiratory ailments and substance abuse disorders, much of which can be improved with routine health screenings and education. However, establishing enough trust to persuade participants to undergo these evaluations and adhere to customizable plans can be a hard-won and humbling battle.
“Fortunately, we’ve only had to send one person by ambulance to [the hospital] for a medical issue,” Gortney says.
There’s no other Wayne State program that’s adopted this interprofessional approach, making the church a one-stop shop for patients without the hassle of setting up appointments, referrals, wait times, transportation and the stigma that can accompany a traditional doctor’s visit. It also provides the students with a crash course in what it’s like to apply knowledge across discipline, an apt lesson of what it will be like working in the health care field after graduation.
It's why Claire Sickon, a doctoral student in the physical therapy program, keeps coming back to CHIP.
“I wanted to educate myself about the other health professions and professionals that my patients may see over the course of treatment,” she says. “I wanted to learn when the right time was to refer and to whom.”
As a social worker, Brydges promotes mental health as part of a holistic approach to healing. She recalls a woman who came in complaining of back pain. Speaking with her, Brydges learned the severity of the pain was preventing the woman from doing work she loved, which contributed to mental struggles.
It helped that woman to talk about it and she left with a smile on her face, Brydges says.
There’s a consensus among the volunteers that they don’t think of CHIP first and foremost as a service project, but as an opportunity to give back to the city and the people who have in turn taught them. They remarked that they don’t have to wait until after graduation to make a difference in patients’ lives.
Since 2014, many CHIP patients have become regulars and now know the students by name, but the hope is always for the patients to become healthy enough to quit the clinic, Gortney says.
She recalls a previously incarcerated man who routinely stopped in for chronic back pain and estradiol inflammation. All he needed was additional medication and regular blood pressure checks. He improved, started working and quit the clinic altogether. While Gortney acknowledges they can never really know where patients end up, she considers that case a success.
“I know we’ve seen at least one person kind of come out of the system,” she says.
She recalls another man who visited the clinic four times before he finally started taking his diabetes medication.
“These small victories may not seem that large, but they’re large in that person’s life.”
The United States Public Health Service and the Interprofessional Education Collaborative agrees—it recently granted CHIP an honorable mention in the 2019 Excellence in Interprofessional Education Collaboration (IPEC) National Award competition. Gortney was invited to present a poster about the project at the IPEC Meeting in Washington, D.C., in June. She says she’s overwhelmed by the recognition and largely credits Wayne State for the success of the program.
“If you look at [Wayne State’s] mission statement, we’re genuinely interested in serving the community. It’s not just lip service. The people here are committed, and because of that, our students develop a heart for serving” and have the opportunities to work with underserved communities. “By having interprofessional experiences, our students are going to be better set for anywhere they go practice.”
CHIP volunteers can attest to that.
“Learning at [Wayne State] in Detroit grants us far more clinical exposure in our curriculum than I could have ever thought was possible,” says Ramy Mana, a Pharm.D. student.
Brydges is already applying all she’s learned at the clinic to her current position as a supervisor to crisis responders for Kids Help Phone, a crisis texting service for youth.
“I’m asking questions in new ways because I witnessed in person how they played out. I’m prepared for what would be an unexpected answer because I’ve heard it before at the clinic.”
While all students pursuing health care degrees at Wayne State must complete so many hours of outreach, many CHIP volunteers exceed the requirements.
“I asked to stay on as an alumna in CHIP because I’m such a big fan of the program and wasn’t quite ready to let go,” Brydges says. “I always leave this clinic feeling amazing, like my Sunday morning really made a difference.”