Medical students plan to keep taking their lessons to the street

ROCHESTER — Local medical students are combining their book smarts with a unique brand of street smarts.

Twenty-seven Mayo Clinic Alix School of Medicine students have been learning about the unique challenges related to caring for people facing homelessness as part of an eight-month-long elective training. The goal is to expose them to the related challenges, but also show that being a physician includes more than addressing medical needs.

“There is so much that goes beyond medical care that can provide a benefit to the community,” said Yong-hun Kim, a second-year student from Chapel Hill, North Carolina.

The student-led street medicine elective program launched with the help of Zumbro Valley Medical Society in September with classes held at the Rochester Community Warming Center.

Several participants said they expect the lessons learned will shape how they approach their future careers.

“I hope it will provide me with the ability to be able to meet every patient where they are, to understand where a patient is in their life and tailor treatment to their circumstance,” said Laura Fabion, a 2017 Mayo High School graduate who returned to Rochester last year as a medical student.

Discussions throughout the program centered on overcoming stereotypes about people struggling with homelessness, as well as lessons on how physicians can care for more than the health of their patients.

Sessions included direct interaction with people experiencing homelessness, as well as local social workers and advocates.

Later work included outreach runs and encouraging the students to find ways to support people struggling with homelessness.

“I think the more students can step out into the community, it’s good for us,” second-year student Jeff Woods said.

The Bedford, Texas, native said he was inspired to help create the medical student selective following a ZVMS-sponsored presentation featuring Street Medicine Institute founder Jim Withers regarding efforts in other communities.

“For me that was the single most inspiring hour of the first year of medical school,” Woods said.

He partnered with Kim and their classmate Tatsumi Yanaba to create an optional course, known as a medical school “selective.”

Such courses typically attract 10 to 12 first- and second-year students, so 27 students in its first year shows it struck a key interest among the 113 first-and second-year medical students in Rochester.

“The kind of student that comes to Mayo, I feel, cares a lot about patients, because Mayo’s core values are that the patient comes first,” Kim said.

Tom Kingsley, a Mayo Clinic physician and president of the Zumbro Valley Medical Society, said part of the program's draw has been its emphasis on interacting with real people.

“In your first and second years, you get limited clinical experience,” he said, adding that the program created a transition from classroom study to when the students will have more hands-on work in their third year.

Students said being able to hear first-hand experiences helped build a greater understanding of the challenges faced by people without shelter, as well as the challenges related to providing care for them.

“I knew there was a population, but I still had a lot to learn, and still do have a lot more to learn,” Fabion said.

As classes continued, students also started getting their own first-hand experiences by making outreach runs with The Landing MN and offering volunteer support for other community programs that assist people facing homelessness.

Even before the selective started, some future classmates took part in a local effort to count the number of unsheltered residents in Olmsted County.

“That was one of the first experiences I had in Rochester, and it felt like that experience really opened my eyes to the importance of understanding what persons experiencing homelessness are going through and making sure they are represented,” said first-year students Jessica Trinh, who later also started helping prepare Saturday meals at Christ United Methodist Church, which are delivered to The Landing for distribution.

Kingsley said such experiences help broaden the outlook for future doctors.

“I think the medical students are quickly learning that health care is beyond managing a wound,” he said. “It can also be about thinking about how to get a person short-term housing and what can be done to transition to longer-term housing while providing the care they need.”

He said those lessons are made more real when they come directly from people the students meet during outreach runs to homeless camps and visits to people at day centers or at local intersections, where people are holding cardboard signs and asking for support from passers-by.

“I think we all learn from our patients and their experience, and the more we can interact with patients and hear their stories, the more we start to understand the challenges,” Kingsley said.

Yanaba, who served two years in the Peace Corps before starting medical school, agreed, saying he feels everyone has something to teach him about the world.

“For about a decade, I’ve enjoyed talking to strangers,” said the second-year student from St. Louis, Mo.

The school year is wrapping up for students this month, but the work with the street medicine effort is expected to continue, even for those who might be taking part of the summer off.

“We’ll still do street runs and outreach runs, but we are not meeting for (classroom) content,” said Beth Kangas, executive director of Zumbro Valley Medical Society.

She’s been connecting students with staff and volunteers from The Landing as they visit people who are struggling with homelessness.

For now, the students are primarily using the time to engage with people and hear about their needs and concerns. However, they are also taking notes about what will be needed to expand efforts to provide care at a campsite, under a bridge or anywhere else they might be able to connect with someone needing help.

“In some ways street medicine seems straightforward, just go out there and see what people are experiencing, and deliver the care you can, but then you realize it’s not that simple,” Woods said. “We do need to know our scope of care, what supplies we need to carry and how we are going to do that in the winter.”

When new first-year students arrive in Rochester this fall, two hours of street medicine education is expected to be in their required course work in the medical school’s “science of heath care delivery” class.

Yanaba said he introduced the idea, which is expected to include one-hour group discussion with people experiencing homelessness as well as a presentation by a provider with experience in serving people without shelter.

“I wanted people to have the exposure, to have the conversations,” he said.

Kangas said it will also open opportunities for the elective program, with plans being made to send students to visit more community programs and find new opportunities to connect to people facing homelessness.

“It will be more of an experiential exposure,” she said, adding that the effort will also seek to build trust between the students and people struggling witienh homelessness.

First- and second-year students are limited in the care they can provide, but Kangas said the information gathered will be used to advance the program with the help of local physicians, as well as other programs, such as Mayo Clinic’s community paramedics and Winona State’s nursing program.

“We see it as part of an integrated system,” she said, pointing to the potential programs to work together.

Retired Mayo Clinic physician Casey Cladwell, who has been providing volunteer health care through clinic space provided by The Landing since September, said the proposed coordination could have a big impact.

“I think it will be good for the community,” said the physician who currently volunteers three days a week out of a construction trailer as The Landing works on establishing a new day center. “It will keep folks out of the ER, and it will help us take better care of the people who otherwise might not get care at all until something bad happens.”

Maj. Lisa Mueller of the Salvation Army agrees, pointing to a benefit in providing consistency in medical intervention.

“We are beginning to put systems in place to intervene and bring medical services to those who are unable or unwilling to access them, but helping this vulnerable population with services that could help prevent illness is lacking,” she said.

Kingsley said he believes the student-led approach to the street medicine program is helping answer that.

“This wasn’t something we were pushing,” he said. “This is something the medical students wanted, and the leadership in the medical school recognized that.”

Students also pointed to support from the school and Mayo Clinic staff.

“It seems like maybe there was already a desire within Mayo to find more avenues for (medical) residents to be of service in the community,” Woods said, also pointing to Mayo Clinic discussions about medical records and insurance coordination with the program.

Anji Ge, a first-year student from Vermillion, South Dakota, said it seems to be a perfect fit in a community that faces rising housing prices and also touts top-notch medical care.

“It’s such a vulnerable population, and Mayo has so many resources,” she said.

Ge, along with Faubion, Trinh and other first-year students are already planning growth for next year’s selective training through Zumbro Valley Medical Society, but that doesn’t mean the students who helped forge the course are stepping back completely, even as they face new challenges in their third years of medical school.

“In my personal statement for medical school, I wrote I wanted to be a doctor who could enable others to be safe, understood and whole,” Woods said, pointing to plans to stay involved in the program throughout his time in Rochester.

Kingsley said the street medicine program remains in the early stages, but he sees the medical students’ enthusiasm for being part of a solution in the community as a positive sign for the future of the program.

“It’s growing faster than we anticipated,” he said.