How the other half screens: A model for partnerships between student-run free clinics and genetic counseling programs to address disparities in hereditary cancer evaluation.

Genetic medicine is considered a major part of the future of preventative care, offering evidence-based, effective interventions to improve health outcomes and reduce morbidity and mortality, especially regarding hereditary cancer screening. Identification of individuals who would benefit from screening is key to improving their cancer-related healthcare outcomes. However, patients without insurance, of historically underserved races, of lower socioeconomic status, and in rural communities have lower access to such care. Barriers to access lead to populations having higher rates of undetected hereditary cancer, and consequently more severe forms of cancer. With an already-established reach, student-run free clinics can work with genetic counseling training programs to incorporate genetic medicine into their workflow. Such partnerships will (1) make genetic care more accessible with goals of improving patient morbidity, mortality, and health outcomes, (2) offer robust educational experiences for genetic counseling learners, particularly in understanding social determinants of health and barriers to care, and (3) actively combat the growing racial and geographic gaps in genetic care. Our study presents how one student-run free clinic implemented genetic counseling into its primary care workflow to improve access to genetics services. We present two examples of how genetic counseling improved patients' medical care. We also identify obstacles encountered during this program's development, as well as solutions-those we incorporated and possible considerations for other clinics. With the hope that other clinics can use this paper to design similar partnerships, we aim to lessen the gap between sickness and screening.

A Cross-Sectional Study of Disparities in Screening Guideline Concordance Within a Student-Run Clinic.

Examination of screening guideline concordance can help clinics and institutions identify and understand disparities within their own practices. We conducted a study to examine whether screening completion rates within a student-run free clinic (SRFC) reflected, exacerbated, or narrowed population-level disparities in outcomes by race/ethnicity and primary language. We compared completion rates for cervical cancer (n = 114), diabetic retinopathy (n = 91), colorectal cancer (n = 114), and breast cancer (n = 63) by race/ethnicity (Black, n = 37; Hispanic, n = 133; white, n = 54; other, n = 29) and primary language (English, n = 106; Spanish, n = 136; other, n = 11) among patients at Shade tree clinic (STC), an SFRC in Nashville, TN. There were no differences in screening completion rate by race/ethnicity, and Spanish-speaking patients had slightly higher rates of cervical cancer screening [91% (95% confidence interval 84-97%)] than English-speaking patients [72% (57-86%)]. Overall screening rates were comparable to national averages, and in the case of screenings performed within clinic-cervical cancer [82%; (75-89%)] and diabetic retinopathy screening [86% (79-92%)]-exceeded national averages and/or affiliated academic medical center goals. These findings extend the existing literature supporting the ability of SRFCs to provide effective care by also demonstrating one measure of equity in clinic processes, providing a framework for future studies of equity within SRFCs and traditional primary care practices.

Addressing Trauma and Building Resilience in Children and Families: Standardized Patient Cases for Pediatric Residents.

INTRODUCTION: Adverse childhood experiences (ACEs) and trauma are common and can negatively impact children's health. Standardized patient (SP) learning may provide trainees with knowledge and skills to screen for and manage ACEs, apply trauma-informed care approaches, and teach resilience strategies. METHODS: With content experts, we developed three SP cases based on common clinical encounters, as well as didactic and debriefing materials. Case 1 focused on somatic symptoms in an adolescent with ACEs, case 2 focused on an ACE disclosure by a parent, and case 3 focused on de-escalation. The workshop required facilitators, SPs, simulation exam room and meeting space, and audiovisual equipment. It lasted 4 hours and included an orientation (1 hour), the three SP cases (totaling 2 hours), and group debriefing (1 hour). RESULTS: We conducted five identical workshops with 22 pediatric residents. Participants responded favorably to case fidelity and applicability to their clinical work. Resident mean self-assessment scores improved significantly from baseline. Specifically, we assessed comfort with inquiring about and discussing ACEs, explaining the health impacts of trauma, identifying protective factors, resilience counseling, and de-escalation. Over 90% of responses indicated that residents were likely to apply what they had learned to their clinical practice. DISCUSSION: These findings demonstrate that our SP cases were well received and suggest that such curricula can help pediatric residents feel more prepared to address trauma and promote resilience. Future work will assess these outcomes, as well as behavior change, in a larger sample to further substantiate these promising findings.