2022-2023 DOCS Annual Report by UMMSM Mitchell Wolfson, Sr. Department of Community Service

2022-2023 Annual Report

University of Miami Miller School of Medicine

Mitchell Wolfson Sr. Department of Community Service

Table of Contents Thank You From DOCS DOCS Mission A Message from Dean Ford DOCS History Our Year in Numbers Hope & Austin: A Patient Story DOCS Clinics Center for Haitian Studies San Juan Bosco Miami Rescue Mission IDEA Clinic DOCS Health Fairs Fort Lauderdale Little Haiti Liberty City West Kendall Florida Keys South Dade Allapattah DOCS & Beyond Regional Medical Campus Emergency Preparedness Patient Navigation MedIT Research & Quality Improvement Community Health Leadership Conference Miami Med Reentry Care Coordination Volunteer Features Student: Esmeralda Segura Fellow: Dr. William Aiken Resident: Dr. Shyam Vedantam Attending: Dr. Dushyantha Jayaweera DOCS Executive Board 1

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A Thank You From DOCS It is hard to believe that we find ourselves at the close of yet another year, bidding farewell to an exhilarating season of DOCS. On behalf of our Wolfson DOCS family, we extend our heartfelt gratitude to all those who have contributed to the success of this year. We are grateful to our philanthropic donors, whose unwavering support empowers us to achieve our goals each year. We are humbled by the dedication of the diligent students and physicians who selflessly donate countless hours at our fairs and clinics. Above all, we want to express our deepest appreciation to the patients and community advocates who continuously inspire our unwavering commitment to serving our community. Their unique stories and experiences serve as a constant source of inspiration for us at every step of our journey. Throughout the past year, our primary objective was to restore a sense of normalcy following the pandemic. We recognized the immense responsibility of reaching out to communities and individuals who had faced significant obstacles in accessing healthcare in recent years. However, through the combined efforts of our donors, community partners, and volunteers, Wolfson DOCS not only addressed the needs of our patients but also expanded the range of services provided to the medically undeserved.

Lastly, we would like to express our profound gratitude to our DOCS faculty advisor, Dr. Amar R. Deshpande, and RMC DOCS faculty advisor, Dr. Julia Belkowitz, for their unwavering guidance and dedication to the success of our program. We must also acknowledge our DOCS Manager, DOCS “mom” and constant pillar of support, Raysa Christodoulou, whose daily assistance and unwavering encouragement to our students are invaluable. The support we have received from them, as well as our DOCS student leaders, has transformed this experience into a cherished time that inspires us to carry the mission of this organization in every aspect of our lives. Although our tenure as Executive Directors has come to an end, we are filled with excitement for the organization’s evolution in the years ahead. We tirelessly worked alongside student leaders, volunteers, and community partners to overcome every challenge on our path back to pre-pandemic operations. Through unwavering collaboration and a shared commitment to improving health in South Florida, we triumphed over the hurdles of the past year. We are confident that the Wolfson DOCS program and the resilient communities it serves will continue to progress and adapt, dedicated to the betterment of our community. Sincerely, Ankit, Tori, and Emily

This year, we commemorate the 22nd Anniversary of the creation of the Mitchell Wolfson Sr. DOCS program. While the Miller School has been hosting community health fairs since the 1970s, it was in 2001 that various medical student groups organizing these fairs decided to unite under the umbrella of the “Department of Community Service.” This collaborative effort has allowed the DOCS program, its health fairs, and clinics to flourish under one unified organization for more than two decades. For each of us, our involvement in DOCS - whether as volunteers, staff members, executive board members, or ultimately Executive Directors - has profoundly shaped our medical school experience and paved the way for our future as physicians. We cherish the unparalleled experiences that DOCS has provided us in terms of leadership, mentorship, and friendship. Every member of the University of Miami Miller School of Medicine who engages with the DOCS program - whether through volunteering at a clinic, participating in a health fair, or presenting at our conference - has the opportunity to grasp the essence of DOCS’ unique mission: providing quality and compassionate care to all patients while fostering an ethos of meaningful healthcare delivery. We want to express our sincere thanks for the remarkable generosity of the Mitchell Wolfson Sr. Foundation. Their unwavering commitment to DOCS enables us to deliver consistent care to the patients in our community while simultaneously training the next generation of physician leaders who will maintain a lifelong dedication to serving the needs of the undeserved. 3

Our Mission

Wolfson DOCS, enlisting the participation of students and physicians of The University of Miami Miller School of Medicine, is dedicated to providing quality healthcare to the undeserved populations in South Florida through the following values:

LEADING

Fostering students’ leadership abilities among, peers, colleagues and patients

From the Dean “The DOCS program represents one of the Miller School’s most fundamental and essential missions: service to our community. Our students and faculty bring medical care to neighborhoods whose residents often have no other way of getting this care. The patients’ gratitude and their hope for good health in the future are an inspiration to all of us. It is a privilege to be the dean of a medical school whose students are so committed to providing compassionate medical care to every member of our community Henri R. Ford, MD, MHA Dean and Chief Academic Officer University of Miami Miller School of Medicine

TRAINING

Demonstrating proficiency in clinical skills through practical experience

E D U C AT I N G

Realizing the importance of not only educating ourselves but also our patients and the communities in which they live 5

The History of DOCS

DOCS Health Fair then...

Since the inception of the first health fair in Big Pine Key in 1971, the students of the University of Miami Miller School of Medicine have made access to care for the medically undeserved a top priority. In academic year 2000-2001, the health fairs formalized into DOCS, a student-run, non-profit organization endorsed by the medical school under the direction of Dr. Mark T. O’Connell. As DOCS gained recognition, a generous donation was received in 2006, endowing the service organization as the Mitchell Wolfson Sr. Department of Community Service. In the 2022-2023 academic year, DOCS brought screening and educational services through its health fairs and clinics to over 1,700 patients thanks to the volunteer efforts of our medical students and physicians. Currently, DOCS holds 9 annual health fairs in undeserved areas in Miami-Dade, Monroe, and Broward counties to screen for the most prevalent health problems in our community, including: hypertension, diabetes, dyslipidemia, obesity, vision and hearing loss, osteoporosis, fall risk, oral health, dementia, depression, HIV, STI, Hepatitis B, Hepatitis C, opioid use disorder, and intimite partner violence as well as colon, breast, cervical, and skin cancers. In addition, DOCS works closely with community partners to increase awareness about local resources. DOCS also operates 4 free student-run clinics that provide treatment in both primary care and specialized services through the Center for Haitian Studies Clinic, San Juan Bosco Clinic, Miami Rescue Mission, and the IDEA Needle Exchange Clinic. Using a referral system from our health fairs to free and reduced-cost clinics, we are able to provide continuity of care and follow-up services by acting as a portal of entry into the healthcare system for at-risk patients.

...D OCS Hea lth Fair s now

Our year in

6152

NUMBERS

Student Volunteer Hours at Health Fairs

1108

196

Pediatric Mobile Clinic patients seen in the first year of partnership with DOCS Health Fairs

Health Fair Patients Screened

668

2421

Patient visits in clinic

Physician Volunteer Hours

301 Patients navigated to longitudinal care

Recipient of Citizens Board Sebastian’s Hero Award for

$50,000

to support new exam tables at the women’s health station, hemoglobin A1c testing, and STI testing 10

2022-23 Health Fair Services Provided A health fair patient story: Diana

900

Diana works for a local non-profit in West Kendall and was excited to hear about a health fair in the area, but she wanted to check out the event for herself before recommending it to her clients. “It was one of the best experiences I have ever had,” said Diana, “From the minute I walked in, everyone was very nice, knowledgeable, extremely kind, and patient.” Before coming to the health fair, Diana had some health concerns. She was able to talk to the physicians at the different health fair stations who eased her concerns and gave her important information to bring back to her primary care doctor. She was grateful that the medical students and physicians took the time to patiently answer her questions and clarify any concerns she had until she fully understood. “I’m referring everyone I know to go to the DOCS health fairs because it is so important. A lot of us cannot afford to go to the doctor, even if we have insurance, and the information you get from the health fair is so helpful.

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Hope & Austin: a patient stor y In 2018, Hope and Austin* were struggling with opioid use and they had both just lost custody of their kids. They were at their lowest point. The two of them decided to start going to the DOCS IDEA Exchange to get clean needles. In their minds, as long as they were getting clean needles, at least they were making steps in the right directions. The IDEA Exchange turned out to be much more than just clean needles. They connected with the IDEA Social Worker, Chevel, while receiving Hepatitis C testing. Sick and tired of doing the same thing every day and lying to their families about their addiction, Hope and Austin told Chevel they wanted to make a change in their lives. Chevel connected them with a Detox facility that same day. Hope and Austin did not think this was going to work, but they felt so defeated that they would try anything. They went to the Detox facility and were connected with follow-up care at the IDEA Clinic upon discharge. Through IDEA, they received medication for opioid use disorder and had frequent check-ins with the team. The two of them were doing very well for many months, but Hope faced a relapse when her sister passed away. She felt like she had reached a new low point and was worried about disappointing the people in her life. She returned to the IDEA team who met her with open-arms. “To be able to tell somebody what happened and then to have no judgment towards me whatsoever was so helpful. It was just really amazing to have that support.” Since then, Hope and Austin have continued receiving their care through the IDEA Clinic but have moved their permanent residence to Key West, where they attended the DOCS Florida Keys Health Fair. They loved working with the students, “They were amazing and were really genuinely interested.” Prior to their recovery journey, Hope and Austin had neglected their other health needs and were uninsured. The 2023 Key West Health Fair was an opportunity for them to get information they both needed including blood pressure checks. “It’s a busy life, so being able to make sure we’re healthy, especially in Key West, because there are so many people here that need resources like that.” Hope told the women with whom she worked about the health fair and many of them were able to bring their children to get the care they needed. Hope and Austin have since regained custody of their children who are spending the summer with them. “To be able to be a good mom to my kids, make them dinner, have them all sit at my table is the most fulfilling thing,” said Hope, “I told Austin, we used to dream about the day we would be able to have them back home and it’s finally here. It was such a long road, but it was all worth it every step of the way.” *Names changed for patient confidentiality

Hope and Austin carry DOCS IDEA Exchange business cards with them to share with people in their community who are looking for help with substance use disorder.

“To be able to tell somebody what happened and then to have no judgment towards me whatsoever was so helpful. It was just really amazing to have that support.” LEFT: Student volunteers at the Key West Health Fair providing services for the pediatric patients including the children of Hope’s co-workers who came to this year’s fair. RIGHT: Chevel, the IDEA Exchange Social Worker who connected Hope and Austin to care at a Detox facility the same day they wanted to make a change. She is pictured picking up medication for opioid use disorder from the Jackson Pharmacy for patients at the IDEA exchange. 14

Welcome to our

CLINICS

LISTEN SERVE LEARN

Center for Haitian Studies San Juan Bosco Miami Rescue Mission IDEA

CENTER FOR HAITIAN STUDIES CLINIC The CHS DOCS Night Clinic is held every Monday night and offers comprehensive primary care services to uninsured individuals at no cost, thereby providing a stable health hub in the Little Haiti community. This care includes diagnostic services, such as ECGs and laboratory evaluations. Multiple students on the CHS staff are phlebotomy trained to draw such labs. The 8 students on the CHS DOCS staff ensure that patients are contacted and scheduled for follow up appointments so that we can establish longitudinal care. In addition, “Women’s Health Nights” are held every six weeks. Staffed by gynecologists, these nights aim to address the dynamic gynecological, reproductive, sexual health needs of patients. We provide STI testing, Pap smears, endometrial biopsies, transvaginal ultrasounds, and colposcopies. IUD insertion and removal is also offered in partnership with Reproductive Health Advocates. Through routine clinic operations, we are not only able to provide patients with high-quality care, but we also provide valuable health education and personally navigate patients through the process of obtaining a Jackson Card, which allows them to access free or low-cost specialty care at Jackson Memorial Hospital. The CHS staff works together with patients to ensure their health goals are met. The partnership between CHS and DOCS has led to increased access of care for those in the Little Haiti community and the larger Haitian diaspora. We currently serve as the sole primary care providers for a panel of over 100 patients.

138 p a t i e n t s v i s i t s

We are very grateful for our patients who allow us to serve them and would like to thank the physicians who donate their time to oversee weekly clinic operations as well as CHS staff, namely Dr. Larry Pierre, Dr. Metellus Georges, Gina, and Sonide for their support in making this clinic a reality. We are also very thankful for the help and support from those on the DOCS Executive board and DOCS staff.

SAN JUAN BOSCO CLINIC The DOCS San Juan Bosco (SJB) Clinic is a student-run, free clinic that serves the uninsured population of Miami-Dade County who are at or below 200% of the federal poverty level. The San Juan Bosco Clinic was founded in 1992 and has been in operation for the last 30 years. Located at Corpus Christi Catholic Church in Allapattah, our patients are mostly Hispanic and Spanish-speaking. The SJB Day Clinic provides patients with primary and gynecologic care, while UM DOCS operates every Tuesday night and rotates through seven different medical specialties: Cardiology, Psychiatry, Neurology, Pulmonology, Rheumatology/Musculoskeletal, Gastroenterology, and Urology. We offer diagnostic imaging and laboratory testing at no cost to patients through Baptist Health System, provide Jackson Card enrollment assistance for access to services at Jackson Health System, and prescribe medications. All prescriptions are coupled with GoodRx coupons and instructions on how to obtain the greatest discount. Some routine medications are available in-office and dispensed from our supply cabinet. For more expensive medications, patients are enrolled in the Prescription Assistance Program.

180

patient visits

Our patients oftentimes need referrals to a variety of services including colonoscopies and endoscopies, sleep studies, and physical therapy. In additiion, this year we faced challenges referring patients to physical therapy with the closure of UM’s LAGOS Physical Therapy Clinic. Seeing that the need was still very much present for patients to have access to this service, we decided to partner with the Physical Therapy Department at the Miller School of Medicine to provide patients with evaluations and treatments in our clinic. PT services planned include pelvic floor therapy, cardiovascular and pulmonary physical therapy, neurology, and orthopedics. We will begin PT nights starting in August 2023. In addition, we have collaborated with the UM DOCS Emergency Preparedness team to offer a CPR training session to patients while they wait to see the doctor on clinic night. This initiative will give patients the opportunity to learn how to perform CPR in hopes to improve the rates of bystander CPR initiation and increase the chances of survival in our community.

As SJB continues to grow and improve, our service to our patients remains at the center of our work. We are very grateful for all who walk through SJB’s doors and place their trust in our care. We would like to thank SJB Executive Director Luz Gallardo, the clinic’s administrative assistant, Sandra Garcia, our volunteer physicians and students, and the DOCS team who give their time and energy towards the fulfilling SJB’s mission of providing quality service to others.

MIAMI RESCUE MISSION CLINIC DOCS’ newest night clinic operates on Wednesday nights out of the Miami Rescue Mission (MRM) Clinic, a primary care clinic during the day for an all-men’s homeless shelter in Overtown and the surrounding area. The specialty care that we provide to the shelter residents eliminates transportation and logistical barriers associated with seeking specialty treatment at Jackson Health System. The MRM Clinic holds rotating specialty nights monthly which we expanded to include dermatology and urology this year in addition to cardiology, pulmology, gastroenterology, and endocrinology.

patient visits

To address the challenges of providing care to this population, we have moved towards centralizing services which include performing labs and dispensing medication on site. If certain medications were difficult to acquire, we coordinated with our volunteer physicians to look for efficacious substitutions that we had at the MRM clinic pharmacy. We plan to increase the frequency of our clinic nights and the range of specialties we offer now that we have completed two years of fully operational service. Thanks to our partnership with the Miami Rescue Mission Day Clinic, homeless shelter residents can receive quality specialty care. In the years to come, we look forward to expanding our clinic and we appreciate the MRM day clinic staff’s help in establishing and maintaining our smooth clinic operation, in particular Gisela Bretones-Graham and Dr. Pete Gutierez. 23

IDEA CLINIC The DOCS IDEA Clinic occurs weekly on Thursday nights and stemmed from a partnership with the IDEA Needle Exchange Program, the first legal syringe exchange program in Florida. The goals of the DOCS IDEA clinic include addressing patient healthcare needs in a timely and comprehensive manner, working with patients to increase their trust in the healthcare system, and providing important educational opportunities for medical students regarding harm reduction. In addition to offering general primary care services and free point-of-care HIV and Hepatitis C testing, student volunteers at our clinic work with dermatology, internal medicine, infectious disease, and emergency medicine physicians to treat skin infections and abscesses that often occur secondary to chronic use of injectable drugs, as well as provide medications for opioid use disorder (MOUD) to assist patients in their recovery. Our physician volunteers educate both students and patients not only in the principles of harm reduction and methods to encourage historically marginalized patient populations to access healthcare, but also in the execution of necessary procedures such as abscess care and prevention. In addition, we offer telehealth appointments to increase healthcare accessibility to our patients. Through these efforts, we have been able to reach a variety of patients with primary care and wound care needs across South Florida.

In June 2019 Governor Ron DeSantis signed the 2019 IDEA Act to expand the Miami-Dade pilot needle exchange program statewide. In collaboration with the DOCS National Health Leadership Consortium, the DOCS IDEA Clinic staff is now providing ongoing support to students at other Florida medical schools looking to expand our clinic model. Through a recent grant, we have been able to provide patients with access to buprenorphine free-of-charge to aid in their recovery from severe opioid use disorder. We would like to thank Dr. Hansel Tookes, Dr. David Forrest, Dr. David Serota, Dr. Teresa Chueng, Dr. Katrina Ciraldo, and the entire IDEA Exchange Staff for their support and guidance.

271

in-person patient visits

telehealth visits 21

Join us at our

H E A LT H FAIRS Fort Lauderdale Little Haiti Liberty City West Kendall Florida Keys:

SCREEN CONNECT PREVENT

Marathon - Big Pine Key - Key West

South Dade Allapattah 25

FORT LAUDERDALE HEALTH FAIR

As the only DOCS fair in Broward County, the Fort Lauderdale Health Fair provides community engagement and health navigation resources not only to the Fort Lauderdale population but for patients throughout the county, many of whom have been coming to the fair year after year. We were so fortunate to hold the 2022 fair at the beautiful new L.A. Lee YMCA/Mizell Community Center with our community partner, the YMCA of South Florida. Nestled in Historic Sistrunk, the L.A. Lee Center stands on the same grounds that Provident Hospital (Broward County’s first African-American hospital) once did, making this a very meaningful location to hold the fair. Our diverse patient population spanned from locals in the Fort Lauderdale area to undeserved community groups in Pompano Beach, and we were ecstatic to serve over 200 patients at the first full scale Fort Lauderdale Health Fair since 2020!

LITTLE HAITI HEALTH FAIR

The Little Haiti Health Fair is hosted annually at the Center for Haitian Studies, a non-profit organization that works with local members of the large Haitian community living in Miami. The ability to partner with and serve the Haitian community makes this fair unique and provides an exciting experience for DOCS students and physicians. The Little Haiti Health Fair was one of the first and longest standing partnerships of DOCS within the greater Miami community. This year, the LHHF team was happy to welcome the Pediatric Mobile Clinic to the Health Fair. The Pediatric Mobile Clinic served over 35 children in this year’s fair, an exciting success. We were able to serve over 90 patients, thanks to our community partners and wonderful medical student volunteers. The LHHF team would like to especially thank the Tabernacle Seventh Day Adventist Church for their continued help along with every other community partner that contributed to the successes of the 2022-2023 Little Haiti Health Fair.

LIBERTY CITY HEALTH FAIR

Liberty City is a community that truly represents the culture and history of Miami. Though just a few miles away from our medical campus, the healthcare challenges that this community faces continue to be evident. Through the Liberty City Health Fair, we aim to address these medical concerns by providing on-site care and resources to community clinics. The Liberty City Health Fair is hosted at Dorsey Technical College, a school that educates health professional students in the Miami area with great success. For the past two years, we have been able to provide clothing, books, and toys to children whose parents attended the fair. We are incredibly lucky to work with such heavily involved community partners, including the Dorsey Technical College team and Ms. Regina Davis, who help us to make this fair a success each year and allow us to provide care to hundreds of patients.

WEST KENDALL HEALTH FAIR

The West Kendall Health Fair provides healthcare screening services to a community that primarily consists of Hispanic immigrants. This was our fifth year partnering with Capilla Del Rey, a church that is located in the heart of West Kendall. This year we had a full-capacity health fair where we were able to host every single health station. This year, our partnership with Feeding South Florida allowed us to provide every patient with high quality fresh produce free of cost. We hosted a successful health fair and we were able to further strengthen our relationship with the church and the local community.

FLORIDA KEYS HEALTH FAIR

What Do You Love About the Florida Keys Health Fairs? Nancy, Volunteer Coordinator for FKHF since 1993 This year marked Nancy’s 30th anniversary of volunteering at the Big Pine Key Health Fair. She is wearing one of her favorite t-shirts designed by one of the University of Miami student volunteers from the 1993 fair. “The Big Pine Key Health Fair has always been fun! And each year we have lots of really good people come, many of whom are the same people who have come over and over again. It is always great and we love to see the fabulous Miami students every year.”

This year marked the 52nd Annual Florida Keys Health Fair hosted by the University of Miami Department of Community Service. This year we were elated to run three health fairs on the same day in Marathon Key, Big Pine Key, and Key West for the first time since the COVID-19 pandemic. With three fairs, we successfully served over 300 patients! Each fair had almost all of the DOCS stations running as well as community vendors to educate and provide for the patients. The Florida Keys Area Health Education Center (AHEC) remains one of our longest partners and supporters. This year they were instrumental in assisting with advertising the fairs and helping us provide to the communities..

Ankit, DOCS Exec Director

Juan, Student Volunteer

Alex, Student Volunteer

“My favorite part of the Keys Health Fair is that we get to run three health fairs simultaneously all around the Keys and see a bunch of patients throughout the day.”

“I love seeing all the familiar faces from previous years coming back to see us as well as hanging out with all of our friends while helping the community.”

“We get to serve the community here in the Keys and have a great time doing it.”

SOUTH DADE HEALTH FAIR

The South Dade Health Fair aims to provide medical care to uninsured, low-income, and migrant worker families in the Florida City and Homestead areas. This year, we were able to increase our community outreach through local organizations to engage those populations who may otherwise lack access to routine health screenings. With these outreach efforts, we were able to provide care to double the number of patients we saw during the pandemic.

ALLAPATTAH HEALTH FAIR

Allapattah is one of the most historic neighborhoods in Miami and is just miles away from our medical campus. We’re incredibly proud to have hosted our second Allapattah Health Fair where we served a significant number of patients in a community where health disparities are great. We more than tripled the number of patients that attended the fair compared to our inaugural fair last year. This year, we hosted 155 patients, 54 of whom were pediatric. We would like to thank the YMCA for their partnership and for opening their food pantry to our patients. We were able to provide lots of fresh fruits and vegetables in addition to our health care services. We look forward to growing the fair next year and further assisting the Allapattah community for years to come!

Clinics, Health Fairs, &

BEYOND

TEACH SUPPORT IMPROVE

Regional Medical Campus Emergency Preparedness Patient Navigation MedIT Community Health Leadership Conference Miami Med Reentry Care Coordination

REGIONAL MEDICAL CAMPUS Guatemalan-Maya Center

The Guatemalan-Maya Center (GMC) is a non-profit community organization located in Palm Beach County that serves the Guatemala-Mayan immigrant population in South Florida. In past years, DOCS has held events such as health literacy workshops focusing on community education topics like diabetes, physical activity, nutrition, and healthcare utilization, along with a simultaneous pediatric program complementing the adult curriculum to engage the children and encourage families to come together. This year, RMC DOCS students worked to host and assist in multiple events in partnership with the GMC, including dermatology consultations, health fairs, and holiday parties. As part of supporting the GMC and providing them with long-term resources, students worked extensively to develop partnerships with other community organizations and Miami resources to connect patients to both primary care services and specialty services, including at the Bascom Palmer Eye Institute and the Sylvester Comprehensive Cancer Center. In addition, medical students partnered with undergraduate students to create health education videos to provide to the community. We hope that building these connections will allow for enduring partnerships, which will help to strengthen access to healthcare for this undeserved community, and that these videos will be a resource that will help in educating the community in years to come.

FLASH Exchange Clinic

The FLASH Clinic is a newer project for RMC DOCS, building off of previous advocacy efforts by past RMC students. FLASH is a syringe service program operated by Rebel Recovery, an organization that serves people who inject drugs and/or are experiencing homelessness in Palm Beach County. Rebel Recovery provides services like needle exchange, naloxone, HIV/ Hepatitis testing, and much more. RMC DOCS students operate a bimonthly mobile clinic in partnership with FLASH, the Department of Health, and local physicians, providing wound care and other medical services to FLASH participants. The clinic, which first started in Fall 2021, now operates at two locations in Delray Beach and Lake Worth. Medical students who volunteer at FLASH clinic with DOCS at the RMC get a unique opportunity to work with people who use drugs or are experiencing homelessness in those participants’ environment. Medical student volunteers get to interact with many participants who will not go to a hospital because of poor treatment, stigma, and negative experiences they have had in the past. Unfortunately, many of our participants have had these experiences, which has made them wary and distrusting of doctors in a normal medical setting. At FLASH clinic, the students work on rebuilding trust in healthcare with the participants. Medical students will get one-on-one experience interacting with people who are currently using drugs and get an inside perspective. Students hear their stories and learn the determinants that go into drug dependence as well as knowledge of safe use practices, drug interactions, what drugs are currently being distributed and used on the street, and different medical complications as they relate to the use of specific substances. Because of the relationship and trust that the participants have built with the employes of FLASH, they know that they are in a place where they will not be judged or have consequences for their drug use. Participants build a close relationship with student volunteers, as they frequently visit to get help with any of their wound concerns. Because of this, they are more honest and open with the medical team.

Healthcare Access The RMC DOCS Healthcare Access (HCA) Project aims to educate and empower students regarding the health insurance and healthcare resources options in Palm Beach and Broward Counties, as well as providing students with public health volunteer opportunities in partnership with the Health Council of Southeast Florida (HCSEF). A major initiative of the Healthcare Access team is to connect students to resources for their patients, including free and reduced clinics and other healthcare resources. The HCA team maintains a digital catalog of resources that can be accessed by a QR code distributed in sticker format to all RMC students and presents on key community resources to all incoming RMC students during their public health and orientation sessions. 37

EMERGENCY PREPAREDNESS The Emergency Preparedness (EP) Response Team organizes hands-on training for medical students in preparation for a variety of emergency situations, coordinates student volunteers for university disaster response, and provides community outreach in emergency and disaster preparedness. This year’s activities included: 1. Stop the Bleed + CPR training: Tactical Emergency Casualty Care Training for students and families. 2. Medical student educational intubation/airway workshops 3. Establishment of CPR education at DOCS SJB clinic with dedicated equipment. 4. Development of how to use naloxone workshops through EP station and education events. The Emergency Preparedness team continued its mission of patient education at DOCS health fairs through the EP Station. At this station, patients learned about hands-only CPR and the Heimlich manueuver, firearm safety and safe gun ownership, and toxicology, and worked with student volunteers to develop individualized hurricane preparedness plans.

PATIENT NAVIGATION

We train about 183 students to serve as patient navigators each year to provide longitudinal follow-up for patients after each fair. Patient navigators follow patients who are risk stratified according to criteria met through screening at the nine health fairs. Navigators assist patients in achieving health goals, such as acquiring health insurance and appointments with physicians at either Jackson Memorial Hospital or local free or low-cost clinics throughout South Florida. The goal of this project is to ensure that patients who attend our fairs are accessing the healthcare system throughout the year so they can receive the necessary long-term medical care. This year, we have continued to expand the integration of patient navigation into the MS1 medical school curriculum to provide all students with this experience at the start of their medical education.

183

STUDENT NAVIGATORS

301

PATIENTS NAVIGATED

In total, we helped 301 patients from the health fairs with patient navigation, including 66 patients with MS1s as a part of their curriculum. Next year, we hope to focus on quality improvement within our patient navigation program. We plan on reaching out to patients who have been navigated within the last two years and asking them about their experience to identify points of improvement within our current navigation system. We also want to assess whether or not they were able to achieve their health care goals through our navigation program.

MEDIT Starting in 2016, DOCS has used Research Electronic Data Capture (REDCap), a HIPAA secure online database often used for research, as an electronic medical record (EMR) system for our community health fairs. Utilizing a custom-built branching logic, DOCS created a user-friendly system that provides patients a unique record number to assist in tracking their information Longitudinally across different years, the medical informatics team (MedIT) assists with real-time data collecting during each health fair and ensures a standardized screening process based on US Preventive Services Task Force guidelines and other specialty-specific society screening guidelines. This year, MedIT worked to continuously improve our usage of technology and improve processes throughout DOCS. We focused on improving the reliability of our team’s internet access while at health fairs as well as continuously optimizing our EMR in REDCap. We also published a paper titled, “Development of an Effective Electronic Medical Record for Student-Run Free Health Fairs Using Research Electronic Data Capture (REDCap) Software” which describes our successes and challenges using REDCap as an EMR and the importance of an affordable system to house patient records for organizations such as DOCS.

RESEARCH & QUALITY IMPROVEMENT The unique structure of DOCS services and our elaborate student network allows us to reach thousands of undeserved individuals in our South Florida communities each year through annual health fairs, weekly clinics, and community partnerships. Research and quality improvement (RQI) projects are an important part of the sustainability and continued growth of DOCS. These projects allow us to evaluate our current processes and develop new initiatives that will help in our ultimate goal of improving the quality of care we provide. RQI also provides an opportunity to disseminate our model to other medical schools that are similarly implementing community health initiatives. We strive to continuously improve the services DOCS provides to South Florida community members and train medical students to advance care in community settings.

This Year’s Projects

This year, UMMSM students proposed and executed nearly 20 projects across DOCS clinics and health fairs. The projects addressed a wide range of topics ranging from the impact of the COVID-19 pandemic on the physical and mental health among South Florida communities attending DOCS health fairs to evaluating a robust patient navigation program. Surveys implemented at DOCS clinics and health fairs sought to expand our understanding of community knowledge and behaviors related to HIV or sun and noise exposures. The results of these surveys will be used to expand DOCS services and health education efforts, tailoring the findings to identified needs in our communities. Another project seeks to provide community CPR training to the Hispanic population at the DOCS SJB Clinic through educational sessions at weekly clinic nights. These projects all seek to improve the care we provide and offer opportunities to expand our services.

COMMUNITY HEALTH LEADERSHIP CONFERENCE CHLC is an annual meeting held by DOCS to create a platform for medical students around the country to share their efforts in addressing community health. Each year we have keynote speakers who discusses their expertise and experiences working with undeserved populations, followed by oral and poster presentations from medical school attendees. This year our keynote speaker was Dr. Hansel Tookes, Assosiate Professor of Medicine in the Division of Infectious Diseases at the University of Miami Miller School of Medicine and the medical director of the Infectious Disease Elimination Act (IDEA) Exchange Pilot Program. We had attendees from 13 different institutions, including the University of Miami, with many peers coming from out-of-state, including California, Texas, Ohio, Georgia, Washington D.C., Alabama, and North Carolina. For the first time, we held a clinic panel moderated by one of our clinic co-directors Esmeralda Segura, which allowed participants from all over the country to discuss their successes and efforts within their own student-run clinics. Following our 6 oral presentations, we had a poster session with 64 presentations. We were so appreciative of all the work and participation of so many medical students and are excited for this conference to continue to grow to its pre-pandemic size.

MIAMI MED REENTRY CARE COORDINATION Returning to the community after incarceration is a process filled with many challenges – accessing transportation, obtaining a job, finding a place to live. For many formerly incarcerated individuals, this return is made more difficult by chronic health problems. Our model is to partner with local organizations working with individuals recently released from prison to identify a cohort of participants interested in receiving patient navigation services. We then match each of these participants with a medical school student trained to work with this patient population and to be a patient navigator. Medical school students and participants initially meet to establish goals and assess a participant’s health literacy. Subsequent meetings occur biweekly for 6 months and focus on achieving health goals and navigating the health system. Specifically, medical student navigators may assist by identifying healthcare insurance options, locating available clinics, making appointments, and providing social support and encouragement. Over the past year, we have developed new community partnerships and collaborations with other DOCS clinics. To accommodate this growth, have also increased our student involvement for a total of 10 patient navigators. Additionally, we are providing Women’s Heath seminars for a cohort of ladies at Homestead Correctional Facility with plans to expand this program to other facilities this year. Our clinic provides medical students with a positive learning environment to build their knowledge of healthcare issues faced by individuals formerly incarcerated and techniques in motivational interviewing. The DOCS Miami Med Reentry Care Clinic is designed to further the mission of the University of Miami Miller School of Medicine by empowering the next generation of physicians to address healthcare disparities and promote the health and well-being of all members of our community.

From CHLC alumnus and current 3rd Year Jackson/UM Med-Peds Resident, Stephanie Lee: “When I applied to residency, I had very little intention of coming to Miami. I was born and raised in Oklahoma City and had no intention of ever leaving. I applied to the program here just to cast a wide net and see what was out there in Med-Peds. I didn’t realize that it was the same institution where I had just had a poster accepted for a conference and that I would be going back two months later to present. I realized this halfway through my interview day and told the Med-Peds program I would be back for an accidental second look. I was kind of skeptical during my interview of whether or not people at UM really did care about caring for the undeserved because it all sounded too good to be true. I went to the confer-

ence and heard about the DOCS fairs and all the work that goes into the community at just the medical student level. It helped me solidify my decision and I ranked here #1.” 43

Hundreds of volunteers made this year possible, here are a few who went above and beyond.

Volunteer Features

INSPIRE TRANSFORM MENTOR

Esmeralda Segura Dr. William Aitken Dr. Shyam Vedantam Dr. Dushyantha Jayaweera

STUDENT FEATURE: ESMERALDA SEGURA University of Miami Miller School of Medicine Class of 2024 What was your role in DOCS during the 22-23 school year and what responsibilities does your role entail? What were you most proud of accomplishing this year? During the 22-23 school year, I served as Clinics Co-Director in which I helped oversee the four clinics, advised clinic staff, and facilitated community partnerships. I am most proud of connecting with and becoming a trusted source of help for clinic project managers as I watched them grow their leadership skills and ease into their roles. I’m also happy to have helped expand our in-house interprofessional collaborations with physical therapy in our San Juan Bosco clinic expected to launch in August.

What do you love about DOCS Clinics? I love that it lets students across all years work together in a health professional setting. It truly has something for everyone. It allows first years to get a head start in seeing patients and apply what you learn in the classroom under the guidance of upperclassmen and faculty. As someone who started off on Zoom, DOCS clinics allowed me to interact with my classmates and do something meaningful while doing so. As a third-year medical student, DOCS clinics gives me the chance to mentor and teach students while helping to build their clinical skills. Lastly, I love meeting patients in their communitues and immersing myself in all the different cultures South Florida has to offer.

How has your role in DOCS impacted your medical school career? What lessons and skills have you learned from DOCS that you hope to carry with you in your future career? The Department of Community Service has taught me a lot as a Project Manager for the San Juan Bosco Clinic and Clinic Co-Director by showing me the behind the scenes of healthcare. I have learned the intricacies of running a clinic, barriers to healthcare, and how being an advocate for your patient is crucial. It has taught me that healthcare is a privilege, and that every encounter with a patient is important. It also taught me that every community is different, and culturally competent care allows you to form deeper connections with your patients and provide better service.

What would you say to students who are interested in getting involved in DOCS? Why do you think it is important for medical students to participate in DOCS? Do it! Try out the different clinics and health fairs and see what speaks to you! You do not need a position or experience to volunteer! I have had some of the best experiences of medical school through DOCS. It is an amazing way to stay grounded and form connections with classmates, physicians, and patients. 47

FELLOW FEATURE: DR. WILLIAM AITKEN UM/JMH Cardiology Fellow, Year 3 What is your current involvement with DOCS? What initially made you interested in becoming involved? I volunteer with Wolfson Department of Community Service (DOCS) through the St. John Bosco (SJB) Clinic, which provides medical care free of charge to uninsured residents of Miami-Dade County. I serve as a preceptor in their Tuesday night cardiology clinic and get to see patients together with students. I remember volunteering at a student-run free clinic in medical school and jumped at the opportunity to volunteer with DOCS when I heard about the great work they do at SJB. Is there a similar program where you went to medical school? Yes! I went to medical school in Chicago and there was a free clinic in the Humboldt Park neighborhood. It was a great learning experience and one of my first exposures to direct patient care. What impact do you see that DOCS has on the communities we serve? DOCS provides an invaluable service to our community by engaging with residents who otherwise don’t have the resources to seek medical attention. I see this directly at SJB when we are able to arrange echocardiograms, ambulatory cardiac monitors, and other diagnostic testing for patients to help get to the bottom of their symptoms. What does DOCS offer to residents and fellows? Residents and fellows who volunteer with DOCS get a great opportunity to see patients who might not otherwise have access to care. They also get to work with and teach students. One of the best parts of DOCS clinic nights has been teaching students everything from history-taking and the cardiac physical exam to talking though the diagnosis and management of a variety of cardiovascular diseases. How has your involvement in DOCS impacted your current practice of medicine? Volunteering with DOCS and seeing the enthusiasm of the students has definitely encouraged me to seek opportunities to continue this type of work once I complete fellowship. What role does DOCS have on medical education? Why is it important for medical students to participate? DOCS is an outstanding way to get students involved in patient care early in their medical careers. Not only does it introduce them to the complexity of healthcare delivery in limited resource settings, but it also shows them the subtleties of patient care and the art of applying what you learn in your medical school curriculum to actual patients. What were your favorite experiences this year while volunteering with DOCS? The best part of DOCS clinic nights has been seeing patients longitudinally with students – it’s a testament to the positive experiences that patients have at the clinic. It’s wonderful to see patients breathing easier after their diuretics are adjusted or that their blood pressure has been better controlled. It’s impactful to hear stories about how patients have stayed out of the emergency room as a result of changes the students have suggested. 48

RESIDENT FEATURE: DR. SHYAM VEDANTAM UM/JMH Internal Medicine Residency, PGY-3 What is your current involvement with DOCS? What initially made you interested in becoming involved? Giving back to the community is very important to me, and I used to participate in community service throughout my time in college and medical school. Unfortunately, the life of a resident doesn’t offer as much free time as I had during those times, especially when I was trying to spend any extra free time working on research projects to apply for a competitive fellowship. But once I was able to “let off the gas,” I wanted to return back to giving back. In doing community service, I like the idea of being able to take what I’ve spent so much time trying to master - medicine and being able to offer that back to the community. In the way that they offer such great learning opportunities in the hospital through their medical diseases, I feel it’s likewise important to take that fund of knowledge to their neighborhood and prevent those potential patients from suffering from those same complications from preventable diseases.

What does DOCS offer to residents and fellows? A pleasant surprise for me was that DOCS offers an opportunity for interns and residents to palpably see how far they have come in medical training. So much of medical training feels like trying to paddle above water and “drink from a fire hydrant.” At times, it can feel like somehow, after putting one foot in front of the other for so many days, I ended up in a being in charge of taking care of people’s lives. The imposter syndrome is real. DOCS offers a chance to take a step back from the high-pressure environment of residency and be involved with medical students who are nervously excited to present a patient for perhaps the first time. It’s a funhouse mirror to see where we were a few years prior and reflect on how much knowledge and skill has been accrued in the interim. It’s also a chance to take skills and knowledge that I didn’t realize I had gained so well over the past 3 years and pass it back to future residents. Volunteering with DOCS is a chance to connect with medical students and be a mentor to someone. I’ve enjoyed working with students in DOCS and then seeing them on rotations in the hospital.

What role does DOCS have on medical education? Why is it important for medical students to participate? I see how early in their training, medical students get practice gathering a history and physical to make an assessment and plan. DOCS gives medical students a chance to actually practice medicine very early on. And, at least I hope when I am there, it can feel like a low-stakes environement without the pressure of grades or trying to impress to get a letter of recommendation. This leads to the development of critical skills, such as presenting a patient well. This skill is the backbone to the latter years of medical school and only becomes more so during residency and fellowship. These “soft” skills become just as important as the “hard” skills embedded in medical curricula. DOCS also gives students early exposure to the longitudinal aspect of medicine in a clinic environment. By participating in multiple sessions, they are able to continuously follow patients and see how their interventions are manifesting in terms of patient outcomes. It’s such a vital part of real-life clinical medicine that is tough to appreciate until you are at least in residency and have your own continuity clinic. 49

How has your involvement in DOCS impacted your current practice of medicine? My primary care clinic is at the Miami Veterans Affairs Hospital. While I get the opportunity to serve our veterans, it’s a very specific population. My DOCS experiences have exposed me to the challenges of practicing medicine with much more limited resources (which my colleagues in our clinic at Jackson Memorial get to experience). I’m learning how to work within the challenges of health literacy, language barriers, and incorporating financial burdens of what might be “ideal” and “best practice” into what I recommend to my patients. What impact do you see that DOCS has on the communities we serve? Coming from another part of the country, I always thought of Miami as a vacation and tourist-industry city. However, there is such a rich and underappreciated culture under the veneer that is advertised in common media. Once becoming involved with the University hospital, the Miami VA, and (especially) Jackson Memorial, I got to appreciate how there is an undeserved population here who are having tremendous difficulties navigating the American medical system. DOCS fills in gaps in medical care for people who would otherwise be missed until complications of their medical problems progress to devastating and life-altering endpoints. What were your favorite experiences this year while volunteering with DOCS? My favorite experiences volunteering with DOCS have been building relationships with the medical students who have put so much effort into making the clinic as successful as it is. Their intelligence, joy, and charm make volunteering a truly wonderful experience and never a chore to do. Another special shout out experience goes to volunteering with the Florida Keys fair. I got to drive down to the Keys during the sunrise, which is an absolutely beautiful drive. It was also fun to have that weekend off in a different type of vacation city compared to Miami and spend that time with medical friends in a non-medical setting.

ATTENDING FEATURE: DR. DUSHYANTHA JAYAWEERA UMMSOM Professor of Medicine, Department of Medicine, Division of Infectious Disease Can you tell us about your involvement with DOCS? I always wanted to interact with DOCS, and I spoke with the leadership, they quickly linked me up. What do you think DOCS has to offer patients, medical students, residents, and physicians? This is a fantastic program. It offers me an opportunity to teach the students and residents. For physicians like me, this gives an opportunity to share the knowledge and experience essential in an academic environment. What impact do you see that DOCS has on the communities we serve? It is critical to expose young medical students to health disparities while serving the underserved and vulnerable populations. What are some of your fondest memories of DOCS? The best is when discussing simple medical problems and the appreciation for being there. Also, sharing a piece of pizza with the students was fun, although I never eat pizza at home!!! 50

2022-23 DOCS Executive Board Co-Executive Directors Victoria Gabor, Ankit Shah, Emily Swafford Clinic Co- Directors Esmeralda Segura, Jose Ramirez Gemma St. Louis, Ron Swonger Health Fair Co-Directors Director of RMC Programs Tara Tardino Breanna Boggan Logistics Director Valerie Vilariño Interprofessional Education Director Medical Informatics Director Kevin Orton Grace Dima Public Relations Director Research and Quality Improvement Co-Directors Kelley Benck, Kiana Winslow Lauren Bystrom, Joseph Deshan Training Co-Directors Kristen Mascarenhas, Lien Morcate Longitudinal Health Access Co-Directors Faculty Advisor Amar R. Deshpande, MD Raysa Christodoulou DOCS Manager