Meah Yasmin S, Smith Eric L, Thomas David C
Mount Sinai School of Medicine, New York, NY, USA.
Mt Sinai J Med. 2009 Aug;76(4):344-56. doi: 10.1002/msj.20128.
In recent decades, the United States has experienced substantial growth in the number of student-run clinics for the indigent. Today, over 49 medical schools across the country operate over 110 student-run outreach clinics that provide primary care services to the poor and uninsured. Despite this development, little research has been published on the educational value of such student-led endeavors. Although much has been surmised, no general methodology for categorizing the learning experience in these clinics has been established. This article represents the first literature review of the novel method of educating students through the operation of a clinic for the underserved. It highlights the student-run clinic as a unique enhancement of medical education that may supplant current curricular arenas in teaching students about systems-based practice principles such as cost containment and financing, resource allocation, interdisciplinary collaboration, patient advocacy, and monitoring and delivery of quality care. The novelty of the student-run clinic is that students place themselves at the forefront of problem solving and system navigation to effectively care for severely disadvantaged populations. This article underscores the student-run clinic as a potentially ideal experiential learning method for preparing young physicians to confront a US healthcare system currently facing crises in cost, quality of care, and high rates of uninsurance. The article stresses the need for outcomes research on the long-term effectiveness of the student-run clinic experience in affecting medical student practice behaviors and attitudes in patient care settings that extend beyond the student-run clinic.
近几十年来，美国为贫困人群设立的学生运营诊所数量大幅增长。如今，全国超过49所医学院运营着110多家学生运营的外展诊所，为贫困和未参保人群提供初级医疗服务。尽管有这样的发展，但关于此类学生主导活动的教育价值的研究却很少发表。虽然人们已经有很多猜测，但尚未建立起对这些诊所学习经历进行分类的通用方法。本文是对通过运营面向服务不足人群的诊所来教育学生这一新颖方法的首次文献综述。它强调学生运营诊所是医学教育的一种独特强化方式，可能会在教授学生基于系统的实践原则（如成本控制与融资、资源分配、跨学科协作、患者维权以及优质护理的监测与提供）方面取代当前的课程领域。学生运营诊所的新颖之处在于，学生将自己置于解决问题和系统导航的前沿，以便有效地照顾极度弱势人群。本文强调学生运营诊所是一种潜在的理想体验式学习方法，有助于培养年轻医生应对当前在成本、医疗质量和高未参保率方面面临危机的美国医疗体系。文章强调需要对学生运营诊所经历在影响医学生在超出学生运营诊所范围的患者护理环境中的实践行为和态度方面的长期有效性进行结果研究。
